Residential Aged Care Sector Research Articles

A community within social and ecological communities: a new philosophical foundation for a just residential aged care sector.

A community within social and ecological communities: a new philosophical foundation for a just residential aged care sector.

Utilising a ‘Community of Practice’ to support pharmacists to work in residential aged care: protocol for a longitudinal evaluation

IntroductionA Community of Practice is briefly defined as a group of people with a shared interest in a given area of practice who work collaboratively to grow collective knowledge. Communities...

Transformational leadership style and holistic accountability mechanisms in not-for-profit organisations

This study examines: (i) the ability of the transformational leadership style of top management to effect holistic accountability in not-for-profit organisations (NFPs) through the use of downward (to clients), upward (to funders) and lateral (to employees) accountability mechanisms; and (ii) a mediating effects model of not-for-profit accountability practices wherein the use of lateral accountability mechanisms mediates the association between transformational leadership style and the use of downward and upward accountability mechanisms. Data from 236 NFPs in the residential aged care sector in Australia were gathered through survey questionnaire and analysed using Structural Equation Modelling. We find that transformational leadership style is significantly associated with the use of downward, upward and lateral accountability mechanisms. We also find that the use of lateral accountability mechanisms mediates the association between transformational leadership style and the use of both downward (full mediation) and upward (partial mediation) accountability mechanisms. The results have implications for the research literature seeking to understand the role of leadership in effecting holistic accountability in NFPs as well as for management and practice in those organisations.

Daytime Sleepiness Predicts Mortality in Nursing Home Residents: Findings from the Frailty in Residential Aged Care Sector Over Time (FIRST) Study.

Excessive daytime sleepiness is an increasingly frequent condition among older adults with comorbidities and living in nursing homes (NHs). This study investigated associations between participants' characteristics and excessive daytime sleepiness (EDS); the ability of the Epworth Sleepiness Scale (ESS) scores, EDS, and EDS severity levels to predict mortality at 12months of follow-up; and the optimal cut-off for ESS to predict mortality among NH residents. Prospective and cross-sectional analysis in a prospective study. Older adults permanently residing in 12 NHs from South Australia. Baseline characteristics including the ESS were collected and mortality at 12months was assessed. Logistic regression analyzed associations between participants' characteristics and EDS (ESS >10). Kaplan-Meier cumulative survival estimates followed by log-rank and adjusted Cox proportional hazards models explored associations of ESS scores, EDS, and EDS severity levels with time-to-incident death. Receiver operator curve analysis assessed the best cut-off for ESS to predict mortality risk. A total of 550 participants [mean (SD) age, 87.7 (7.2) years; 968 (50.9%) female]. Malnutrition [adjusted odds ratio (aOR) 2.02, 95% confidence interval (CI) 1.13‒3.61], myocardial infarction (aOR 1.91, 95% CI 1.20‒3.03), heart failure (aOR 2.85, 95% CI 1.68‒4.83), Parkinson's disease (aOR 2.16, 95% CI 1.04‒4.47) and severe dementia (aOR 8.57, 95% CI 5.25‒14.0) were associated with EDS. Kaplan-Meier analyses showed reduced survival among participants with EDS (log-rank test: χ2= 25.25, P < .001). EDS predicted increased mortality risk (HR 1.63, 95% CI 1.07-2.51, P= .023). ESS score of 10.5 (>10) was the best cut point predicting mortality risk (area under the curve= 0.62). EDS predicts mortality risk and is associated with age-related comorbidities in NH residents. Screening for EDS is a simple strategy to identify NH residents at higher risk of adverse outcomes, triggering an assessment for reversibility or conversations about end-of-life care.

The impact of the COVID-19 pandemic on the residential aged care sector

The impact of the COVID-19 pandemic on the residential aged care sector

The Impact of the COVID-19 Pandemic on People With Cognitive Impairment Residing in Aged Care Facilities: An Integrative Review.

This review explored the impact of the COVID-19 pandemic on people with cognitive impairment living in aged care facilities. It also considered policy and organizational responses to COVID-19, and makes recommendations to ameliorate the impact of the pandemic on residents with cognitive impairment in aged care facilities. ProQuest, PubMed, CINAHL, Google Scholar, and Cochrane Central were searched April-May 2022 for peer reviewed articles, and an integrative review of reviews was conducted. Nineteen reviews were identified which referred to people with cognitive impairment living in residential aged care facilities (RACFs) during COVID-19. Negative impacts were highlighted, including COVID-19 related morbidity and mortality, social isolation, and cognitive, mental health and physical decline. Few research articles and policy responses consider people with cognitive impairment in residential aged care. Reviews highlighted that social engagement of residents should be better enabled to reduce the impact of COVID-19. However, residents with cognitive impairment may have inequitable access to communications technology for the purposes of assessment, health care and social engagement, and require more support (along with their families) to access this technology. Greater investment in the residential aged care sector (eg, for workforce and training) is required to address the significant impacts of the COVID-19 pandemic on people with cognitive impairment.

Senior manager leadership competencies for quality residential aged care: an Australian industry perspective

BackgroundDocumented poor quality and standards of care in Australia’s residential aged care (RAC) sector have highlighted a need to better understand the role of and skills required by, RAC senior management personnel to address these concerns. This study examined which senior management leadership skills and personal qualities are necessary to deliver and strengthen the quality of RAC, with the aim of improving understanding of the professional development needs of leaders in the sector.MethodsWe conducted 12 in-depth interviews with Australian aged care industry experts, including academics, and representatives from the primary health network, consumer, and provider advocate groups. Abductive, thematic analysis incorporated coding derived from existing leadership skills frameworks as well as inductively identified themes.ResultsIdentified leadership skills were grouped into five domains including i) workforce development and retention, ii) governance and business acumen; iii) health systems knowledge; iv) stewardship and v) responding to regulatory and political contexts. Skills particularly emphasised by participants were those required to recruit and retain a skilled workforce, manage relationships, and promote a positive organisational culture and employee wellbeing.ConclusionsRAC senior managers require a complex mix of business, human resource management, and clinical skills to deliver quality care in Australia’s complex RAC setting. The lack of any professional development framework to guide the acquisition or updating of those skills is a concern.

An exploratory study of workers in the residential aged care sector of New Zealand: what drives them to stay or leave?

PurposeThis study analyses the different factors contributing to the retention and turnover of local- and overseas-born workers in the elderly care sector as an integral part of ensuring a stable workforce and quality care for the growing elderly population.Design/methodology/approachUsing a respondent-driven sampling method, a sample of individuals who worked or are working in residential aged care facilities in Dunedin, New Zealand were surveyed.FindingsThe factors associated with intention to stay or leave are not necessarily the same factors influencing workers to leave.Practical implicationsPolicies need to consider how to make workers want to stay and address the issues that make workers leave the aged care sector.Social implicationsResults of this study can be used to develop more relevant labour and migration policies that reflect a more grounded insight into the experiences of those who are directly and personally affected by these policies.Originality/valueThere are limited international or national empirical studies on the economics of care worker migration and the labour market. This study can provide practical policy advice to help improve recruitment and retention strategies for care workers in countries dependent on global labour markets for health workers. In New Zealand, changes in policies concerning remuneration and immigration highlight the importance of ensuring that care worker needs are met both financially and in terms of institutional support.

National Survey on the Impact of COVID-19 on the Mental Health of Australian Residential Aged Care Residents and Staff

ABSTRACT Objectives This study is the first to obtain data on the prevalence of, contributors to, and supports required for, pandemic-related distress within the residential aged care sector in Australia. A nested mixed-methods approach was used to examine aged care leaders’ opinions about the impact of COVID-19 on the mental health of aged care residents and staff. Methods A total of 288 senior staff of Australian residential aged care facilities (care managers, clinical care coordinators, and lifestyle team leaders; mean age = 52.7 years, SD = 10.3) completed an online survey between 10th September and 31st October 2020. Results On average, nearly half of their residents experienced loneliness (41%) and a third experienced anxiety in response to COVID-19 (33%). The most frequently noted contributors to poor mental health among residents were restrictions to recreational outings and watching news coverage relating to COVID-19. Participants emphasized the need for increased access to counseling services and improved mental health training amongst staff. Residential care staff were similarly impacted by the pandemic. More than a third of staff were reported as anxious (36%) and 20% depressed, in response to COVID-19. Staff were worried about introducing COVID-19 into their facility and were impacted by news coverage of COVID-19. Staff would feel supported by financial assistance and by increased staff-resident ratios. Conclusions Senior staff perceive that the mental health of Australian aged care residents and staff was negatively impacted by the COVID-19 pandemic. The most noted contributors were identified, as was the mental health support for aged care communities. Clinical Implications This study provides government and policymakers with clear intervention targets for supporting the sector. Clinicians can support residential aged care communities by providing on-site or telehealth counseling, and upskill and train residential aged care staff on how to respond to the emotional needs of residents in response to COVID-19.

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.

A cluster randomised trial of the program to enhance adjustment to residential living (PEARL): a novel psychological intervention to reduce depression in newly admitted aged care residents

BackgroundDepression rates are high in residential aged care (RAC) facilities, with newly admitted residents at particular risk. New approaches to address depression in this population are urgently required, particularly psychological interventions suitable for widespread use across the RAC sector. The Program to Enhance Adjustment to Residential Living (PEARL) is a brief intervention, designed to provide individually tailored care approaches to meet the psychological needs of newly admitted residents, delivered in collaboration with facility staff.MethodsPEARL will be evaluated using a cluster randomised controlled design, comparing outcomes for residents who participate in the intervention with those residing in care as usual control facilities. Participants are RAC residents aged 60 years or above, with normal cognition or mild-moderate cognitive impairment, who relocated to the facility within the previous 4 weeks. The primary outcomes are depressive symptoms and disorders, with secondary outcomes including anxiety, stress, quality of life, adjustment to RAC, and functional dependence, analysed on an intention to treat basis using multilevel modelling.DiscussionPEARL is an intervention based on self-determination theory, designed to reduce depression in newly admitted residents by tailoring day to day care to meet their psychological needs. This simple psychological approach offers an alternative care model to the current over-reliance of antidepressant medications.Trial registrationACTRN12616001726448; Registered 16 December 2016 with the Australian New Zealand Clinical Trials Registry.

Causal links associated with missed residential aged care.

To estimate and model the types and frequencies of care that nurses and carers self-identify as being missed in the Australian residential aged care sector. The study advances missed care research to explore how the care of elderly Australians is compromised. A multi-variate approach was used to apply the consensus scores of 2,467 staff to missed opportunities for resident health promotion and restorative care. Eight latent care variables have direct predictor effects on missed Australian residential aged care, all of which are largely under the control of residential care management, with the exception of the physical locality of the aged care settings. Missed care, associated with maximizing the residents' life potential, relieving their distress and maintaining their current health can be quantified and predicted. Aged care policies that maximize adequate staffing numbers with appropriate levels of skill are paramount to minimizing missed Australian residential care.

Adjusting to life in a residential aged care facility: Perspectives of people with dementia, family members and facility care staff.

To determine factors that facilitate or impede adjustment to residential aged care (RAC) from the perspectives of residents with dementia, families of residents with dementia and facility staff. The transition to a RAC facility can be highly stressful for people with dementia and their families, but we lack an understanding of how people with dementia experience this transition. Knowledge on adjustment to the new environment is essential in order to develop procedures and interventions that better support residents. This study consisted of interviews with 12 residents with dementia who had resided at a RAC facility for six months or less; 14 family members of RAC residents with dementia; and 12 RAC facility staff members. Parallel interview schedules were constructed, with questions on the experience of relocating to RAC for a person with dementia and views on enablers and barriers to successful adjustment. Thematic analysis guided the analysis of data. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines (see Supplementary File S1). Adjustment to RAC appeared variable, with several residents reporting poor acceptance of their circumstances several months after the relocation. The three groups were largely congruent regarding the importance of support from families and staff, and the development of new relationships with other residents, but not all residents had succeeded in forming friendships. The provision of meaningful activities and opportunities to exert autonomy day-to-day were seen as critical, but staff experienced challenges in providing individualised care due to lack of dedicated time to engage with residents. There is a need for evaluated interventions to help people with dementia to successfully transition to RAC. Attention should be paid to the way in which care is coordinated within the RAC sector, to enable staff to provide individualised approaches to facilitate adjustment.

Exploring the feasibility, sustainability and the benefits of the GrACE + GAIT exercise programme in the residential aged care setting.

BackgroundThe feasibility and benefits of a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (Group Aged Care Exercise + GAIT (GrACE + GAIT)) in the residential aged care (RAC) setting was investigated as very little peer-reviewed research has been conducted in relation to exercise programmes of this duration in this cohort.MethodsA quasi-experimental study design consisting of two groups (control and exercise) explored a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (GrACE + GAIT) in two RAC facilities in Northern New South Wales, Australia. A total of 42 adults consented to participate from a total of 68 eligible residents (61.7%). The primary outcome measures were feasibility and sustainability of the exercise programme via intervention uptake, session adherence, attrition, acceptability and adverse events. Secondary measures included gait speed and the spatio-temporal parameters of gait, handgrip muscle strength and sit to stand performance.ResultsTwenty-three residents participated in the exercise intervention (mean (SD) 85.4 (8.1) years, 15 females) and 19 in the control group (87.4 (6.6) years 13 females). Exercise adherence was 79.3%, with 65% of exercise participants attending ≥70% of the sessions; 100% of those originally enrolled completed the programme and strongly agreed with the programme acceptability. Zero exercise-related adverse events were reported. ANCOVA results indicated that post-intervention gait speed significantly increased (p < 0.001) with an 18.8% increase in gait speed (m/s).DiscussionThe GrACE + GAIT programme was shown to be feasible and significantly improve adults living in RAC facilities gait speed, handgrip strength and sit to stand performance. These results suggest that the GrACE + GAIT programme is suitable for use in the RAC sector and that it has the potential to reduce disability and improve function and quality of life of the residents.

The relationship between workplace characteristics and work ability in residential aged care: What is the role of work-life interaction?

To examine whether the work-life interface (through work-family conflict and overall work-life balance) moderates the relationship between work ability and workplace demands and resources. This study used a cross-sectional survey design to collect data from 426 employees working in residential aged care. A paper-based questionnaire was distributed to all permanent and casual employees at eight aged care facilities in Melbourne, Australia, between June - September 2013. Moderation analyses were conducted using PROCESS v. 2.13 in SPSS v. 22. As expected, workplace demands and resources directly influenced workers' work ability. In addition, moderate-to-high levels of work-family conflict and low-to-moderate levels of satisfaction with work-life balance combined interactively with particular workplace demands and resources (relationships with management, physical demands, and safety climate) to reduce work ability. This study advances understanding of how work-life balance and work-life conflict can influence work ability levels and shows that addressing the work-life interface may be a legitimate means to improve work ability, potentially leading to continued workforce participation. Staff retention in the residential aged care sector needs to be addressed. One possible means of achieving this is through improving work ability. This study expanded knowledge of how the work-life interface may influence work ability. The research demonstrated that relationships between work ability and particular workplace demands and resources were moderated by the work-life interface. This finding has implications for how human resources managers of residential aged care facilities may improve workforce retention-through facilitating employees to manage the work-life interface better.

Late-life living and care arrangements of older Filipino New Zealanders.

To explore the living and care arrangement plans of older Filipino immigrants in New Zealand. New Zealand is rapidly becoming the host to an increasing number of ageing Filipino immigrants. Despite this sizeable population growth of ageing Filipinos in New Zealand, still very little is known about this ethnic group's care needs and living arrangement preferences in later life within the New Zealand context. Qualitative descriptive approach. Data were collected from 15 older Filipinos who participated in face-to-face interviews. Data were analysed using a thematic analytical framework. Two major themes were identified from the data analysis. The first theme "preferred living and care arrangements" is about older Filipinos' preferred plans for future residence and in receiving care when no longer able to function independently in their own homes. The second theme "negotiating readiness and acceptance" is about hypothetical situations that older Filipinos described and anticipated that will greatly facilitate their readiness and acceptance to living in aged care facilities. The study results have implications for service delivery within the New Zealand residential aged care sector. Due to an increasing number of older Filipino immigrants requiring care, residential aged care facilities must ensure their care models meet the needs of this growing group of older people. Nursing staff skill sets in the aged care sector require sensitivity to older immigrants' health needs without compromising cultural beliefs and practices while living in residential aged care facilities.

Attracting and retaining personal care assistants into the Western Australia (WA) residential aged care sector

ABSTRACTThe Australian population is ageing, with around one quarter being 60 years and older, and the proportion is expected to grow in the future. These trends have led to government projections for the number of personal care assistants (PCAs) needed to meet the demands of the ageing population, estimated to be more than double the current workforce by 2050. Consequently, the challenges associated with attracting and retaining PCAs in the aged care sector need to be urgently addressed. This qualitative study is based on a large and distributed residential aged care organisation located in Western Australia. Its focus is on the employment conditions of PCAs, their satisfiers and dissatisfiers, and the human resource management practices which might assist the organisation and its sector to better address PCA concerns, leading to more effective PCA attraction, selection and retention. A number of strategies have been proposed that are intended to help advance policy and debate, including attention to various HRM practices and factors relating to job quality.

Director of nursing experiences of a hospital in the nursing home program in South East Queensland

In Australia there is limited access to acute care support for residents living within the residential aged care sector. Competing demands from families, residents, government agencies and the acute care sector has meant that staff with the sector struggle often to meet the acute care needs of residents, leading sometimes to transfer of residents to emergency departments with major hospitals. Hospital in the nursing home is a care delivery model designed to reduce transfers, facilitate appropriate care intervention, effectively utilize existing health resources, and extend support to the residential care sector. This research project used an interpretive qualitative framework to explore through focus group method, hospital in the home experiences of 20 residential care Directors of Nursing in South East Queensland. Research outcomes emphasize hospital in the nursing home as a mutually beneficial support strategy that can improve residential based management of acute and chronic illness, can positively assist family support, and assists with decision making and ongoing communication. Hospital in the home emphasises a move from hospital destination based acute care services to community based delivery supported by a multidisciplinary team.

Attracting and retaining Australia’s aged care workers: developing policy and organisational responses

By the year 2060 Australians aged 65 and over will account for one quarter of the population, one in six Australians will be aged 75 or more, and the ‘very old’ (over 80 years of age) will also become more numerous. These statistics indicate that there will be increased demands on the residential aged care workforce in the future and associated labour shortages given the consequent increases in demand for personal care worker services. Moreover, personal care workers (PCWs) are reportedly older than the average age of workers in other fields, further exacerbating these problems. Consequently, this study focuses on both the policy and human resource changes required in the residential aged care sector related to both current and future challenges experienced in attracting and retaining Australia’s ageing aged care workforce. Proposed changes include far-reaching policy development required to underpin improved employment conditions, salaries, training and career pathways as an imperative to care for elderly Australian citizens.

Need or right: Sexual expression and intimacy in aged care

This paper explores how the residential aged care sector could engage with residents' sexual expression and intimacy. It is informed by a study of 19 aged care staff members and 23 community members, and initially designed on the principles of Appreciative Inquiry methodology. The data were collected through focus groups and interviews and analyzed using discourse analysis. We found that staff members mainly conceptualize sexual expression as a need to be met, while community members (current and prospective residents) understand it as a right to be exercised. We conclude that the way in which sexual expression is conceptualized has critical implications for the sector's engagement with this topic. A ‘needs’ discourse informs policies, procedures and practices that enable staff to meet residents' needs, while a ‘rights’ discourse shapes policies, practices and physical designs that improve residents' privacy and autonomy, shifting the balance of power towards them. The former approach fits with a nursing home medical model of care, and the latter with a social model of service provision and consumption.