Residential Aged Care Research Articles

Nurses' attitudes, beliefs and knowledge of sleep health in residential aged care: An integrative literature review.

To identify, synthesize and evaluate primary research on registered nurses' (RN) knowledge, attitudes and beliefs about sleep health and sleep health management of older adults living in residential aged care. Integrative review. Medline, Embase and CINAHL databases from inception to September 2023. Databases were searched using a combination of key words, subject heading terms. All abstracts and full-text articles were screened by two researchers. Qualitative synthesis of the included articles was conducted. Inductive content analysis was used to identify themes and analyse data. A total of 923 abstracts were screened resulting in a final yield of 13 articles. Three themes were identified: (i) RN experience with sleep-disturbed residents, (ii) the emotional burden of sleep disturbances on RN and, (iii) organizational barriers to promoting resident's healthy sleep. Inappropriate administration of benzodiazepines and psychotropic drugs to manage residents' sleep disturbances was a major issue and lack of resources in residential aged care to facilitate sleep. There were concerns on nursing activity that disturbed residents' sleep and striking a balance between facilitating sleep and meeting managerial expectations was challenging. This review identified that nurses' decision-making has an integral role in the management of sleep health in residents in aged care. Whilst evidence-based guidelines for managing sleep in residential aged care are available, there is a lack of translation to practice. Understanding RN perspectives is critical to improving sleep health models of care in residential aged care. This review found that RN are attuned to the implications of sleep disturbance in residential aged care but are constrained by current sleep health models of care. Not applicable.

Effective fall prevention exercise in residential aged care: an intervention component analysis from an updated systematic review

ObjectiveThe effect of fall prevention exercise programmes in residential aged care (RAC) is uncertain. This paper reports on an intervention component analysis (ICA) of randomised controlled trials (RCTs), from an...

Dietitians' perceptions of employment models used in Australian residential aged care facilities.

The qualitative study aimed to explore dietitians' perceptions of employment status and engagement models with residential aged care facilities (RACF) and the impact on work activities and resident care. Dietitians currently working in RACF were recruited through convenience and snowball sampling, including contacting a list of dietitians who had previously consented to be contacted for research. A semi-structured interview guide was developed by the research team, pilot-tested and then used in each individual interview. Data were analysed using constant comparison and reflexive thematic analysis. Thirty-one dietitians (n = 29 female; median age, 39 years) with a range of experience working in different employment status and engagement models in RACF participated in an interview. Five themes were identified: (1) Being an employee allows for better integration and utilisation in the RACF, (2) Contract work creates a scarcity of time, (3) Ad hoc work does not meaningfully address nutrition challenges and may not be good for resident care, (4) Regularly scheduled visits support positive outcomes for residents and (5) Acknowledging many different employment models. Characteristics of engagement models likely affect dietitian work job satisfaction, individual resident care and food service in RACF. Regular dietetic engagement in RACFs is required to support resident-centred evidence-based dietetic practice and to improve residents' nutrition care. There is an opportunity for policy mandates to assist RACFs in regularly engaging a dietitian to ensure all residents have access to timely, high-quality nutrition care.

Understanding the important characteristics of neighbourhoods to facilitate ageing in place and longevity.

This study investigates which local area characteristics, included in the Healthy Ageing/Vulnerable ENvironment (HAVEN) Index, are the strongest factors predicting transition into permanent residential aged care (PRAC) and mortality, and the geographic distribution of these factors. A retrospective cohort study of older individuals living in the community in Adelaide who received their first eligibility assessment for age care services between 2013 and 2015 (n = 16,939) was conducted. The study cohort, from the Registry of Senior Australians (ROSA), was linked by postcode to HAVEN Index items, selected following item response theory (IRT) analysis to determine the strongest local area factors associated with PRAC and mortality. Geospatial mapping of the factors determined the geographic distribution of these significant factors. Fourteen HAVEN Index items were associated with entry into PRAC and mortality. Three area-level items, lower educational attainment, financial housing stress and low levels of volunteering by older people, were risk factors for entry into PRAC and mortality while the remainder of the items identified were different for each outcome. The mapped local area risk factors for each outcome highlighted similar geographical areas of vulnerability. Local area characteristics are associated with entering PRAC and mortality. Our findings can inform area-level responses to make neighbourhoods more age-friendly, potentially allowing more people to age longer in place. Similar analyses, conducted for other areas, could provide evidence to support the widespread development of age-friendly neighbourhoods reducing area-level inequalities in ageing.

‘The Sanctuary’ – developing a human-animal model to promote health in a supported residential aged care setting

Abstract Human-animal relationships are vital for many older persons. Finding ways to include animals in aged care settings can be part of reorienting aged care settings from a solely humancentric focus to a human-animal inclusive one for the 21st century. This case study project report describes the development of an animal inclusive model of care for a Residential Aged Care Facility (RACF) in a regional town in Australia. The model’s primary objective was to facilitate residents’ empowerment through safe engagements with animals as a source of health and wellbeing while incorporating best practise animal-care and husbandry. Exemplars used to inform the model included The Eden AlternativeTM and Care Farms. The Sanctuary model sought to cover several gaps identified in these approaches. These included clear policies and protocols regarding animal welfare, infrastructure needs (animal housing and designated human-animal interaction areas), staffing models, stakeholder engagement approaches (both within the RACF and the local community) and developing sustainable resourcing and financial frameworks. A vision to establish a refuge for both humans and animals was inherent in the design of the Sanctuary model, and to operationalize this vision, policies, resourcing plans and practical processes were formulated informed by multi-species ethical understandings. Regrettably, it was not possible to fully implement the model. However, this case study is presented with the aim of seeking to redress the noted 85% wastage of global health research; a wastage that includes human-animal research knowledge. Insights into opportunities and barriers and experiential knowledge are shared with the aim of facilitating future endeavours to implement parallel visions that embed human and animal inclusive models in residential aged care in the future.

Personal care workers' intention to stay in residential aged care: An integrative review.

To identify key factors that influence personal care workers' (PCW) intention to stay in residential aged care (RAC). PCWs are the 'backbone' of providing direct care in RAC settings. The well-being of older people hinges upon their dedication and commitment; thus, enhancing their intention to stay is a priority to reduce turnover and ensure continuity of care. Six databases were searched for articles focusing on factors influencing PCWs' intention to stay in RAC. Studies were independently assessed for quality using the Joanna Briggs Institute Methodology for systematic review tools. Reporting of the results followed the PRISMA guidelines. Eight articles published between 2010 and 2022 were included. The key issues were categorized as: (a) sociodemographic characteristics; (b) psychological factors; (c) workplace factors and (d) job satisfaction. Older age, being married and immigration status were positively associated with intention to stay. Work stress and burnout contributed towards demotivation, while a supportive and engaging organizational culture that recognized workers' contributions and provided appropriate remuneration and benefits, enhanced job satisfaction and retention. This review affirms the complexity of the decision-making process influencing workers' intention to stay. A comprehensive understanding of the interplay of these factors and the personal and sociocultural challenges faced by PCWs is essential to design strategies to provide support and enhance job satisfaction and retention. This review showed that support from the organization is critical in improving PCWs' intention to stay in aged care. Given the interconnectedness of a range of key factors, decision-makers need to address modifiable factors holistically. Including PCWs in planning retention strategies could be the missing link in tailoring interventions towards workforce retention. Personal, psychological and workplace factors alone and in combination influence personal care workers' intention to stay in residential aged care (RAC). The interrelationships among the factors impacting PCWs' intention to stay are complex, wherein a change in one often influences other factors. Addressing the causes of psychological stress, improving workplace culture and understanding their interrelationships provide a foundation for co-designing strategies to promote intention to stay among PCWs in RAC. The authors have adhered to relevant EQUATOR guidelines PRISMA. This integrative review is conducted with no involvement or contribution from patients or the public.

Adverse Drug Event–Related Hospital Admissions among Australian Aged Care Residents: A Cross-Sectional Study

ObjectivesTo investigate the proportion, characteristics, causality, severity, preventability, and independently associated factors for adverse drug event (ADE)–related admissions in aged care residents admitted to the major public hospitals in Tasmania, Australia. DesignRetrospective cross-sectional study. Setting and ParticipantsResidential aged care facility (RACF) patients aged ≥65 years who had an unplanned admission to one of the 4 Tasmanian public hospitals between July 1, 2018, and June 30, 2021. MethodsWe accessed the medical records of RACF patients. The ADEs were initially identified via chart review and a trigger tool. Hospitalizations attributable to ADEs were then determined by expert consensus. The causality, preventability, and severity of each ADE admission were assessed using standard criteria. ResultsNinety-one residents (18.2%) of 500 randomly selected experienced potential ADE-related hospitalizations. ADEs were considered possible (n = 58, 64%) or definite/probable (n = 33, 36%). The most common ADEs were falls (n = 19, 21%), hypotension (n = 16, 18%), and confusion or delirium (n = 10, 11%). ADEs were frequently associated with renin-angiotensin system inhibitors (n = 43, 47.3%), opioids (n = 43, 47.3%), and diuretics (n = 40, 44%). Most ADEs were of moderate severity (n = 90, 99%) and considered not preventable (n = 60, 66%). Rheumatologic disease [odds ratio (OR) 1.89, 95% CI 1.09-3.30; P = .024] and previous adverse drug reaction (ADR) (OR 12.91, 95% CI 6.84-24.37; P < .001) were associated with ADE hospitalizations. Conclusions and ImplicationsThis study highlights that hospitalization for moderately severe ADEs is common among RACF residents. Opioids and antihypertensives were the common drug classes associated with harm. Rheumatologic disease (due to opioids) and previous ADR were identified as independently associated factors, which may warrant tailored interventions.

Australian Residential Aged Care Facilities Managers’ and Nurses’ Experiences In Implementing Telehealth and Social Connection During COVID-19

Introduction: Residential aged care facility (RACF) residents are highly vulnerable to severe infection and death from COVID-19. During the pandemic, telehealth (telephone and video) provided a mechanism to deliver for health care and social support. We examined logistical factors associated with telehealth, reasons for its use and barriers associated with the choice of telehealth. Methods: A mixed method exploratory study. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using a hybrid framework approach; deductive analysis followed by inductive analysis for sub-themes. Results: Participants (n=19) reported an increase in telehealth use during COVID-19. Organisations bought new equipment, predominately tablets; half had internet connectivity difficulties; nurses used personal devices to overcome connectivity issues or inadequate devices and 74% used three or more platforms/software. Few residents had personal digital devices or could connect with family and friends alone. Five key sub-themes emerged from qualitative data. 1. Needing and persisting with telehealth. RACFs had limited video telehealth use before COVID-19. 2. Being dependent on health providers offering telehealth services. Telehealth was used for a broad range of services. However, many health providers did not offer telehealth consultations. 3 Residents living with dementia. Telehealth was suitable for residents with dementia, depending on the disease stage and clinical need. 4. Challenges with implementing telehealth consultations. Most challenges pertained to workflows. 5. Suitability of videoconferencing for social connection. Staff supported residents with video calls which were highly valued. Conclusion: To capitalise on and sustain telehealth activity in RACFs, further guidance and support to overcome operational barriers are required.

"Time is a Big Factor": Aged-Care Workforce Perspectives on Communication Partner Training for Working With Residents With Dementia.

Many individuals who reside in permanent residential aged care (RAC) have a diagnosis of dementia, with the majority experiencing a communication disorder. Existing literature has placed an emphasis on the need for staff to undertake communication partner training. This study aimed to investigate the preferences of RAC staff, and their perceived barriers and facilitators to workplace training. Through an exploratory cross-sectional online survey, a sample of RAC workers in Australia were recruited (n = 104). Descriptive statistics revealed that the majority of participants preferred training to be delivered face to face and being paid for participation. Through content analysis of open-ended questions, seven categories were identified regarding perceived barriers and facilitators for communication partner training in the workplace. These included staff shortages, time pressures, remuneration and training delivery method, and quality of the educators. Additionally, management attitudes were pertinent. These findings may inform the development and outcomes of future communication partner training in RAC.

COVID-19 outbreaks in residential aged care facilities: an agent-based modeling study.

A disproportionate number of COVID-19 deaths occur in Residential Aged Care Facilities (RACFs), where better evidence is needed to target COVID-19 interventions to prevent mortality. This study used an agent-based model to assess the role of community prevalence, vaccination strategies, and non-pharmaceutical interventions (NPIs) on COVID-19 outcomes in RACFs in Victoria, Australia. The model simulated outbreaks in RACFs over time, and was calibrated to distributions for outbreak size, outbreak duration, and case fatality rate in Victorian RACFs over 2022. The number of incursions to RACFs per day were estimated to fit total deaths and diagnoses over time and community prevalence.Total infections, diagnoses, and deaths in RACFs were estimated over July 2023-June 2024 under scenarios of different: community epidemic wave assumptions (magnitude and frequency); RACF vaccination strategies (6-monthly, 12-monthly, no further vaccines); additional non-pharmaceutical interventions (10, 25, 50% efficacy); and reduction in incursions (30% or 60%). Total RACF outcomes were proportional to cumulative community infections and incursion rates, suggesting potential for strategic visitation/staff policies or community-based interventions to reduce deaths. Recency of vaccination when epidemic waves occurred was critical; compared with 6-monthly boosters, 12-monthly boosters had approximately 1.2 times more deaths and no further boosters had approximately 1.6 times more deaths over July 2023-June 2024. Additional NPIs, even with only 10-25% efficacy, could lead to a 13-31% reduction in deaths in RACFs. Future community epidemic wave patterns are unknown but will be major drivers of outcomes in RACFs. Maintaining high coverage of recent vaccination, minimizing incursions, and increasing NPIs can have a major impact on cumulative infections and deaths.

Evaluation of an exercise program incorporating an international cycling competition: a multimodal intervention model for physical, psychological, and social wellbeing in residential aged care.

The transition into residential aged care is frequently associated with a reduction in physical activity, social engagement, and emotional wellbeing. Our aim was to evaluate the impact of a 26-day international cycling competition (Road Worlds Competition for Seniors), incorporating elements of exercise, audiovisual cycling footage, social engagement, and gamification, on the physical, psychological, and social well-being of aged care residents. We aimed to use findings to inform the development of a multi-modal intervention model to maximise wellbeing for older adults. Residents (N = 32) participated in a mixed-methods single-group intervention pilot study that compared pre-and post-competition measures for the following wellbeing domains; physical, psychological, and social. In addition, interviews were conducted with residents (n = 27) and staff (n = 6) to explore their experiences. Measures identified significant improvements across multiple wellbeing domains, including functional fitness, depression, self-efficacy, and social network sizes. Findings from the interview data indicated that the multimodal components involved in the program delivery were valued by staff and residents who enjoyed the gamification, audiovisual cycling footage, social engagement, opportunities for reminiscence, and camaraderie between peers, staff, and volunteers. Findings highlight a constellation of benefits across physical, psychological, and social domains of wellbeing and inform a model for innovative multidimensional programs in residential aged care. The benefits for residents with varying physical and cognitive abilities support the use of creative strategies that maximise inclusion and engagement for residents.

Caring for Older Patients: Quality and Efficiency of Australia's Healthcare System

AbstractWith population ageing and increased longevity, Australia faces pressing policy issues on caring for older people. As Medicare turns 40, it is timely to assess how the system has been performing, and what changes are needed to modernise Medicare. This article examines the quality and efficiency of care using hospital administrative data. We find that the current system provides good quality and efficient care for older patients, except for those living in residential aged care homes. These patients receive lower quality care yet stay longer in hospitals. We suggest alternative approaches designed around bundled payments and a single budget holder to provide incentives for integrated team‐based care.

SAFE – A risk management tool to protect both people and pets in residential aged care facilities

Abstract Pet ownership has known health and well-being benefits for people of all ages. Most previous research on pet ownership among older people has focussed on older people with pets living independently in their own homes or the effects of visiting pet programs in residential aged care. With structural ageing of populations globally, the number of humans living into old age is increasing. Even with home support and care policies, an increasing number will need to live in communal aged care settings. Currently, pets rarely accompany older persons into communal residential aged care. This article presents a risk management tool – Safe Animal Friendly Environments (SAFE) – designed to facilitate and maintain private pet ownership among older people living in residential aged care facilities. SAFE was developed to identify best practice for both human and animal well-being in residential aged care. The tool supports both human and animal well-being during a human stage of life with many losses and pains while reducing the number of pet animals needlessly relinquished or even euthanised when owners need to ‘go into care’. It was developed using a Delphi process with multidisciplinary expert input. We identify the different types of risks for stakeholders (residents with pets, aged care facility staff and pets), including physical, zoonotic and psychological risks. None of the identified risks of pets in aged care are unmanageable. SAFE reduces risks to acceptable levels and directs how to remove them where possible. SAFE has a summative table listing 17 general risks: from animals to humans, humans to animals and animals to animals. Each identified risk has a pre-mitigation risk assessment (low, medium or high), recommended mitigation actions and a post-mitigation risk rating (low, medium or high). Post-mitigation risk is reduced to ‘low’ in almost all scenarios. SAFE has separate tables for dogs, cats, small mammals, birds and fish, each preceded by a best practice case study. The discussion links the Ottawa Charter for (human) health promotion and use of SAFE. SAFE contributes to the inclusion of residential aged care as a context for the personal human-animal bond.

Osteoporosis management in Australian aged care facilities: a mixed method study

SummaryOsteoporosis is a common but sub-optimally managed disease amongst aged care residents. Pharmacists undertaking comprehensive medication reviews is one strategy to improve osteoporosis management. Analysis of pharmacist medication review recommendations has identified common clinical practice issues that can be addressed to optimise osteoporosis management for aged care residents.PurposeThis study investigates the prevalence of osteoporosis medicine use amongst Australian aged care residents and explores drug-related problems (DRPs) identified during medication reviews and pharmacist recommendations to resolve them.MethodsResident demographics, medications, diagnoses, osteoporosis related DRPs, and recommendations to resolve them were extracted from medication review reports. A mixed methods approach was taken to analysis, involving descriptive statistical analysis and content analysis.ResultsMedication review reports relating to 980 residents were collected. Antiresorptive therapies were used by 21.7% of residents, of which 87.2% were prescribed denosumab. Osteoporosis related DRPs represented 14.0% of all DRPs identified by pharmacists. Vitamin D was involved in 55.4% of these DRPs, the remainder concerned antiresorptive therapies (23.4%), medications contributing to osteoporosis (16.3%), and calcium (4.9%). Frequent deviations in practice from aged care clinical guidelines and consensus recommendations concerning vitamin D and calcium were found. DRPs and accompanying recommendations relating to denosumab revealed inadequate monitoring and inadvertent therapy disruptions.ConclusionPharmacist identified DRPs and recommendations revealed common aspects of clinical practice that can be addressed to improve osteoporosis management for aged care residents. A need to raise awareness of aged care-specific consensus recommendations concerning vitamin D and calcium is evident. Facility protocols and procedures must be developed and implemented to ensure safe and effective use of denosumab.

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...

The changing health-care system in Ghana: forms of care within residential aged care facilities in urban Accra

PurposeThe emergence of residential aged care facilities (RACFs) within the Ghanaian health-care system has raised eyebrows because, hitherto, the concept of nursing homes had largely been perceived as an anomaly. The purpose of this study is to understand this emerging phenomenon and the activities of care provided within two facilities in the nation’s capital, Accra.Design/methodology/approachThe study draws on participant observations and in-depth interviews with purposively sampled 15 residents in the two facilities and eight caregivers. The data were analysed using thematic approach.FindingsThe study found that the daily forms of care mostly performed for the elderly were intimate and non-intimate physical, medical, emotional and spiritual and end-of-life care. The bulk of activities of care were performed in the morning.Originality/valueThe study reveals that the changing landscape of health-care facilities in Ghana to include RACFs indicates RACFs have come to stay to provide different forms of care to older persons who otherwise were cared for by the family.

How Much Does Dysphagia Cost? Understanding the Additional Costs of Dysphagia for New Zealand in Patients Hospitalised with Stroke

Introduction: Dysphagia (i.e., disordered swallowing) is a consequence of stroke. Existing literature on the marginal cost of dysphagia after stroke is limited and ignores long-term impacts. Our aim was to determine the marginal 12-month cost attributable to dysphagia, including health-related quality of life (HRQoL) impacts, among patients hospitalised with stroke in New Zealand. Methods: Secondary analysis of observational data from the REGIONS Care study, a national study from New Zealand of consecutively hospitalised patients with acute stroke between May 1, 2018, and October 30, 2018, including an outcome survey at 12 months among those who provided consent. Patients were identified as dysphagic if they received a swallow screen in hospital resulting in a speech language therapist review. Patients that required a nasogastric feeding tube in hospital were classified as “severe.” Optimal linear propensity score matching was utilised to provide a group of patients to compare with stroke and dysphagia. All costs were converted to 2021NZD. Results: Overall, of the 2,379 patients in the REGIONS cohort (51% male, median age: 78), 40% (944/2,379) were dysphagic (52% male, median age: 78), and 5% (111/2,379) were classified as severely dysphagic. Within 12 months of hospital discharge, dysphagia reduced HRQoL overall by 0.06 index points (95% CI: 0.028–0.100), and severe dysphagia by 0.12 index points (95% CI: 0.03–0.20). The estimated marginal 12-month cost attributable to stroke-related dysphagia was NZD 24,200 on average per patient. This estimate includes the additional hospitalisation costs (NZD 16,100), community rehabilitation services (NZD 570), hospital level aged residential care (NZD 4,030), and reduced HRQoL (NZD 3,470) over a 12-month period post-hospital discharge. The overall total marginal cost for those with severe dysphagia was NZD 34,000 per patient. Conclusion: We report cost estimates to 12 months from a national perspective on the additional costs and HRQoL outcomes of dysphagia for people hospitalised with stroke in New Zealand. Findings provide a novel contribution internationally since few prior studies have extended beyond the acute hospital phase of care. By quantifying the economic burden, we provide information to decision makers to improve dysphagia management strategies and ultimately enhance the overall HRQoL for people with stroke and dysphagia.

Acceptability of teledentistry use among residents and staff in aged residential care facilities in the Otago region of New Zealand.

To assess ARC residents' and staff perceptions of the benefits of, and comfort with, teledentistry use in ARC facilities in the Otago region of NZ, and identify end-user-level factors associated with its use. Difficulty in accessing oral healthcare services is a key barrier to aged residential care (ARC) residents' oral health and well-being. Teledentistry offers a possible solution, yet studies on its acceptability in ARCs are sparse, especially in New Zealand (NZ). This study assessed ARC residents' and staff perceptions of the benefits of, and comfort with, teledentistry use in ARC facilities in the Otago region of NZ and identified end-user-level factors associated with its use. Rest home-level residents and care staff in ARC facilities in the Otago region of NZ were surveyed to assess their awareness of teledentistry, perceptions of benefit and comfort using teledentistry, and end-user-level factors associated with the feasibility of using it in ARCs. One hundred residents and 77 care staff from 14 facilities participated. Three-quarters of resident participants thought that teledentistry was beneficial. Three in five resident participants were comfortable receiving remote dental consultations and care advice through teledentistry. Acceptability, as measured by perceived benefits and comfort, was lower among older participants. Staff participants were receptive to teledentistry use for residents and were comfortable facilitating remote dental consultations and care through teledentistry. No staff participants disagreed with the potential benefits of teledentistry for ARC residents. Teledentistry would likely be acceptable to residents and staff in ARC facilities in NZ, contributing to residents' improved access to oral health care and improved oral health and well-being.

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.

A LITTLE BIT OF EXERCISE GOES A LONG WAY – INCREASING INDEPENDENCE OF AGED CARE RESIDENTS WITH PARKINSON’S DISEASE

INTRODUCTION &amp; AIMS Supporting people with Parkinson’s Disease to remain active when living in residential aged care (RAC) is assumed to have benefits, such as reducing falls risk, improving ability to transfer independently, and reducing time spent being sedentary. However, many RAC-facilities are under-resourced making it difficult for staff to support residents with exercise. Accredited exercise physiologists (AEP) enable residents to improve or maintain movement through exercise. The aim of this study was to establish feasibility and value of AEP-services for people with Parkinson’s Disease in RAC. METHODS A 12-week AEP-led exercise program was delivered at multiple RAC-sites across Perth. An individualised exercise plan was designed for each participant, comprising 2 x 50-minute supervised group sessions per week, together with a 15-minute unsupervised morning program. Baseline and follow-up testing was undertaken by the AEP, inclusive of balance (mini-Balance-Evaluation-System-Test (miniBESTest)), mobility (2-minute-walk-distance, Actigraph), fatigue (PD fatigue scale) and quality of life. Descriptive analysis will be presented, reflecting the total hours of AEP-training provided, room attendance records from RAC-staff, and changes in pre-post balance, mobility, falls, quality of life, depression, behaviour, and fatigue. RESULTS To date, five participants have enrolled (3 women; 2 men) (recruitment is ongoing). Individual results for baseline testing showed the range of abilities and challenges for these participants (Mini-BESTest range of 5-16 and 2-minute walk distance of range 0-61). Not all tests could be completed by all participants. Post-test and change scores will be presented. CONCLUSION Due to the clinical heterogeneity of the disease, the AEP is required to prescribe according to each individual needs whilst maintaining the fidelity of the exercise intervention. Challenges have been presented with conducting research in this environment including recruitment of participants due to level of cognition, conflicts with participant scheduling, operational needs of the facility and facility closures (Covid- and gastro-outbreak).