Residential Care In Australia Research Articles

Implementing mandatory COVID-19 vaccination for Australian aged care workers.

Implementing mandatory COVID-19 vaccination for Australian aged care workers.

Specialised psychiatric beds and 24-hour residential care in Australia 2018-2019 - Comparative analysis and commentary according to international benchmarking.

A commentary on Australian specialised private and public psychiatric acute and non-acute inpatient care, and 24-hour-staffed community residential care with regard to international benchmarks. Descriptive analysis of specialised psychiatric beds from the Australian Institute of Health and Welfare (AIHW) with the WHO Mental Health Atlas 2020, and an international Delphi consensus on optimal and minimal psychiatric beds per capita. Australian private sector beds have shown a 3.8% annual growth rate from 2014-15 to 2018-19, in contrast to relatively static public sector bed numbers. Australia's national combined public and private psychiatric bed number (hospital acute and non-acute, and 24-hour-staffed community residential) of 48.8 per 100,000 population is lower than the WHO European (100.6) and World Bank High Income (69.2) medians, due to fewer community residential and non-acute beds. Australia's 40.9 general and stand-alone psychiatric beds per 100,000 are below the Delphi consensus optimal level of 60 beds per 100,000, but above the bed shortage threshold (30 per 100,000). Rising bed numbers in private hospitals have contributed to Australian psychiatric inpatient capacity, although the level remains below comparable international medians. Recent initiatives to increase psychiatric bed numbers may signal a policy shift in the public sector, complementary to private and community care.

The 'tipping point': Exploring the factors associated with entry into residential care for people with dementia in Western Australia.

People with dementia usually prefer to live in the community. Research is needed to identify the 'tipping point' for residential care entry and to highlight how people with dementia can be supported to remain at home as long as possible. Few previous studies have examined caregivers' perceptions and explanations for the reasons people with dementia need to enter residential care in Australia. To explore the factors contributing to people with dementia entering residential care in Perth, Western Australia, from the perspectives of informal carers and care staff. This phenomenological study used purposive sampling to recruit informal and formal caregivers of people with dementia. Semi-structured in-depth interviews were conducted with 13 family carers and 11 home care staff. Data were thematically analysed to identify individual, carer and contextual factors that impact on residential care entry. The majority of participants identified a combination of factors as the 'tipping point' to residential care entry; a few also identified the cause as a sudden event or specific issue. Factors identified included deterioration related to worsening cognition, changed behaviours and a decline in the performance of activities of daily living; co-occurring health conditions; safety concerns; carer no longer able to meet care needs; impact of providing support becoming too much for the informal carer; lack of family or social support and needing assistance from services that were unavailable or inaccessible. Factors assisting people with dementia to remain living at home longer were family and social support, formal services and dog ownership. This study identified individual, carer and contextual factors that contribute to people with dementia entering residential care in Australia. The 'tipping point' was recognised as when the needs of a person with dementia outweigh the capacity of their informal and formal carers, services and supports to care for them.

What is known about child sexual exploitation in residential care in Australia? A systematic scoping review

The Royal Commission into Institutional Responses to Child Sexual Abuse in Australia noted that child sexual exploitation (CSE) was a significant issue of concern for children and young people in residential care, as increasing rates of sexual abuse and exploitation are continually reported. Employing a systematic scoping methodology, this review examined the scope and breadth of literature focusing on children and young people living in residential care in Australia who have experienced sexual exploitation. Findings indicate that peer to peer sexual re-victimisation is a serious concern in residential care. Entrapment in this kind of abuse is associated with a downward spiral of ‘pain-based’, complex behaviours, which in turn may render young people in residential care to be at even greater risk. Although prevention program responses are emerging, they remain constrained by the secretive nature of CSE and wider systemic issues. As such, a central recommendation emerging from this review is the need for a proactive and consistent approach to data collection and analysis of CSE in residential care settings. This will enable a comprehensive analysis of the aetiology of the problem, enabling the development of prevention responses to match the identified problem.

Clustered domestic model of residential care is associated with better consumer rated quality of care.

ObjectiveTo compare consumer rated quality of care among individuals living long-term in homelike clustered domestic and standard models of residential care in Australia.DesignCross-sectional study.SettingSeventeen residential aged care facilities in four Australian states providing alternative models of care.Study participantsA sample of individuals with high prevalence of cognitive impairment living in residential care for 12 months or longer, not immediately in palliative care and having a proxy available to provide consent and assist with data collection. Of 901 eligible participants, 541 consented and participated in the study.Main outcome measureConsumer rated quality of care was measured using the Consumer Choice Index–6 Dimension instrument (CCI-6D) providing a preference weighted summary score ranging from 0 to 1. The six dimensions of care time, shared-spaces, own-room, outside and gardens, meaningful activities and care flexibility were individually evaluated.ResultsOverall consumer rated quality of care (Mean ∆: 0.138, 95% CI 0.073–0.203 P < 0.001) was higher in clustered domestic models after adjusting for potential confounders. Individually, the dimensions of access to outside and gardens (P < 0.001) and flexibility of care (P < 0.001) were rated significantly better compared to those living in standard model of care.ConclusionsHomelike, clustered domestic models of care are associated with better consumer rated quality of care, specifically the domains of access to outdoors and care flexibility, in a sample of individuals with cognitive impairment. Including consumer views on quality of care is feasible and should be standard in future evaluations of residential care.

Informal care relationships and residential aged care recommendations: evidence from administrative data

BackgroundThe Australian government recognises the importance of informal care to enable ageing in place. Yet, few multivariable studies have examined aspects of informal care that alter the probability of entry to residential care in Australia. Existing Australian and international studies show differing effects of informal care on entry to residential care.MethodsWe utilise unique administrative data on aged care assessments collected from 2010 to 2013, consisting of 280,000 persons aged 65 and over. Logistic regression models were fitted to measure the propensity to be recommended care in a residential care setting, disaggregated by characteristics of informal care provision.ResultsProviding some explanation for the divergent findings in the literature, we show that close familial carer relationships (partner or child) and coresidence are associated with recommendations to live in the community. Weaker non-coresidential friend or neighbour carer relationships are associated with recommendations to live in residential care for women, as are non-coresidential other relatives (not a child, partner or in-law) for both males and females. Non-coresident carers who are in-laws (for females) or parents have no impact on assessor recommendations. Despite these significant differences, health conditions and assistance needs play a strong role in assessor recommendations about entry to residential care.ConclusionCo-resident care clearly plays an important protective role in residential care admission. Government policy should consider the need for differential supports for co-resident carers as part of future aged care reform.

Sticking with us through it all: The importance of trustworthy relationships for children and young people in residential care

Both historical and contemporary residential care for children have been found to present risks to their safety and security. Views about the characteristics of workers that helped them to feel safe in the placement were obtained from 27 children and young people who were placed in residential care in Australia. Competent and trustworthy staff were considered essential. These workers were characterised as caring, proactive, tenacious in building relationships, and available. Importantly, they listened and ensured young people had a voice. The study affirms the central role of the worker-client alliance in ensuring residential care is a positive and safe experience for children and young people, and identifies structural factors that children and young people believe are barriers to them feeling safe.

Weighing Up the Evidence and Local Experience of Residential Care

Therapeutic residential care is currently seen as an answer to managing the increasing disruption experienced by many young people in care. Yet the history of residential care in Australia is problematic and the international evidence for the efficacy of therapeutic approaches is very poor. The author's own agency's experience of providing residential care also indicates that caution is needed before increasing the numbers of residential ‘beds’. Problems include young people's dislike of residential options and the stressfulness of an environment that involves shift workers and multiple transient relationships. Further, residential care can be a financial drain on child welfare budgets (being tendered to non-government agencies at over seven times the cost of community care), and has the potential danger – when beds are empty – of being used for young people who do not need this level of care. Residential care may appear to be the only option for a handful of adolescents no longer suited to foster care; but before developing therapeutic residential care further, government must be able to guarantee, at a minimum: a safe environment, a nurturing and healing environment, continuity of care, and the capacity to meet young people's developmental and permanency needs. These standards must be met, not just now, but over the long term.

“It's not as easy as saying, ‘just get them to eat more veggies’”: Exploring healthy eating in residential care in Australia

Young people living in residential out-of-home care (henceforth OoHC) are at increased risk of becoming overweight or obese. Currently, recognition of the everyday mechanisms that might be contributing to excess weight for children and young people in this setting is limited. The aim of this study was to better understand the barriers and complexities involved in the provision of a ‘healthy’ food environment in residential OoHC. Heightening awareness of these factors and how they might compromise a young person's physical health, will inform the development, refinement and evaluation of more sensitive and tailored weight-related interventions for this population. The paper presents a nuanced picture of the complexity of everyday food routines in residential care, and illustrates the ways in which food is ‘done’ in care; how food can be both symbolic of care but also used to exercise control; the way in which food can be used to create a ‘family-like’ environment; and the impact of traumatic experiences in childhood on subsequent behaviours and overall functioning in relation to food. It is argued that a health agenda designed for a mainstream population ignores the very complex relationship that children in residential OoHC may have with food. It is recommended that future intervention approaches account for personal food biographies, trauma and children's social backgrounds and how these are implicated in everyday practices and interactions around food.

The Views of Service Providers on the Challenges Facing Young People Also Involved in the Youth Justice System Transitioning from Out-of-Home Care

Young people transitioning from out-of-home care placements (either home-based care or residential care in Australia) are a particularly vulnerable and disadvantaged group. This study reports on a research project based on a partnership between our university and seven non-government child and youth welfare agencies in the Australian State of Victoria. A key aim was to identify factors that present challenges to successful transitions from care. The interviews and focus groups conducted with 77 stakeholders revealed major concerns in areas such as disability, substance use, sex work, early parenthood, mental health, family relationships, and finances. Some key implications for policy and practice reform are identified.

A Social Work Practice Reflection on Issues Arising for LGBTI Older People Interfacing With Health and Residential Care: Rights, Decision Making and End-of-Life Care

This article is a social work practice reflection on issues arising for lesbian, gay, bisexual, transgender, and intersex (LGBTI) older people interfacing with health and residential care in Australia; focusing on clients, families, and carers in relation to rights, decision making, and end-of-life care. The article explores relevant case examples from social work practice in a health and residential care setting that highlight some specific complexities of working with this client group. This article brings greater attention to issues arising for older LBGTI when interfacing with health and residential care and has the potential to improve practice for social workers and other health professionals and improve outcomes for LGBTI older people.

“The Food Here Is Tasteless!” Food taste or tasteless food? Chemosensory Loss and the Politics of Under-Nutrition

A common complaint voiced by older people living in residential care is that the food lacks taste. When older people find food tasteless, the pleasure gained from eating and therefore, their appetite may be compromised, as will their food choices, nutrition, immune systems, functional status and well-being. However, often nurses overlook these symptoms as 'inevitable and irreversible' aspects of ageing, which they are not. In fact, many older people experience chemosensory (taste and smell) disorders or loss which means they lose the ability to taste the flavour of food. Commonly overlooked is the fact that chemosensory loss may well be a significant contributing factor to the high level of under-nutrition reported in residential care in Australia. Our purpose in this article is to explore important issues related to taste and smell dysfunction; the physiology of these sensations; several causes distinct from ageing; and interventions to help older people again enjoy their food with the concomitant advantages to their health and well-being. We also consider the way in which legislation related to Government funding has influenced gerontological nurses' assessment skills and values, particularly concerning nutrition assessment to the detriment of not only older people living in residential care but also the profession of gerontological nursing. Attention is drawn to the need for nurses to up-date their clinical knowledge, assessment skills and practice including enhancing the flavour of food and the social occasion of dining for older people living in residential care.

Benchmarking clinical indicators of quality for Australian residential aged care facilities

To undertake exploratory benchmarking of a set of clinical indicators of quality care in residential care in Australia, data were collected from 107 residents within four medium-sized facilities (40-80 beds) in Brisbane, Australia. The proportion of residents in each sample facility with a particular clinical problem was compared with US Minimum Data Set quality indicator thresholds. Results demonstrated variability within and between clinical indicators, suggesting breadth of assessment using various clinical indicators of quality is an important factor when monitoring quality of care. More comprehensive and objective measures of quality of care would be of great assistance in determining and monitoring the effectiveness of residential aged care provision in Australia, particularly as demands for accountability by consumers and their families increase.

Residential care in Australia, Part II: A review of recent literature and emerging themes to inform service development

This is the second of a two-part discussion about the development of residential care services in Australia. It contains a review of some of the recent literature on residential care from Australia, the UK, Canada and the USA. It concludes with a look at the major themes and issues that emerge from this literature as well as the service trends and developments canvassed in Part I.

Residential care in Australia, Part I: Service trends, the young people in care, and needs-based responses

This is the first of a two-part discussion of the place of residential care services in Australia, which highlights the issues that are likely to influence the development of these services into the future. This paper explores service trends over the past few decades, the current place and focus of residential care services, the nature of the young people being placed into such services, and the imperative for developing a more needs-based approach to service delivery. It concludes with a review of recent calls for the development of therapeutic or treatment-orientated models and the initial steps in this direction that have been taken around the country.

Intraclass correlation coefficients from three cluster randomised controlled trials in primary and residential health care

Objective: This paper provides intraclass correlation coefficients (ICCs) for estimation of sample size inflation required in future cluster randomised trials in primary or residential care.Methods: Three cluster randomised trials were conducted among middle‐aged and older adults in primary care and residential care in Australia and New Zealand between 1995 and 2002. Baseline means or proportions, mean change, and ICCs with their standard errors and 95% confidence intervals are reported for outcome variables used in the three studies. The ICCs were estimated from a one‐way random effects model using the analysis of variance method.Results: ICCs for quality of life and psychological variables in the primary care studies were low (below 0.018). ICCs for clinical and physical activity variables ranged from 0 to 0.08. ICCs for health and functional status in residential care for the elderly were high, ranging from 0.025 to 0.514.Conclusions: The magnitude of the intraclass correlation varies with the venue of the trial, the outcome variables used, and the expected effect of the intervention. However, the intraclass correlations provided will be useful for more appropriate planning of residential and primary carebased trials in the future.

Serum vitamin D and falls in older women in residential care in Australia.

To determine the prevalence of vitamin D deficiency in older people in residential care and the influence that the level of vitamin D may have on their incidence of falls. Prospective cohort. Residential care facilities for older people in several states of Australia. Six hundred sixty-seven women in low-level care and 952 women in high-level care, mean age 83.7 years. Serum 25-hydroxyvitamin D (25D) levels and recognized risk factors for falls including current medication use, a history of previous fractures, weight, tibial length (as a surrogate for height), cognitive function, walking ability, and frequency of going outdoors were determined. The women in low-level care and high-level care were followed for an average of 145 and 168 days, respectively. Falls were recorded prospectively in diaries completed monthly by residential care staff. Vitamin D deficiency (defined as a serum 25D level below 25 nmol/L) was present in 144 (22%) women in low-level care and 428 (45%) in high-level care. After excluding 358 bed-bound residents and adjusting for weight, cognitive status, psychotropic drug use, previous Colles fracture, and the presence of wandering behavior, log serum 25D level remained independently associated with time to first fall. The adjusted hazards ratio was 0.74 (95% confidence interval=0.59-0.94; P=.01), implying a 20% reduction in the risk of falling with a doubling of the vitamin D level. Vitamin D deficiency is common in residential care in Australia. A low level of serum vitamin D is an independent predictor of incident falls.

Use of In-Patient Hospital Beds by People Living in Residential Care

Background: There is concern that people living in residential care in Australia make significant and often inappropriate use of acute in-patient hospital services. To date, no factual information has been collected in Australia and its absence may allow myths and negative stereotypes to proliferate. Objective: To determine how and why people living in residential care in Australia use in-patient hospital beds. To determine the outcome of hospitalisation and functional status at 3 months following discharge. Methods: Prospective study of 184 consecutive admissions to hospital following Emergency Department (ED) attendance involving people aged over 65 years and living in residential care in southern Adelaide, South Australia. Information was obtained from the facilities’ transfer letters, and where these were inadequate or absent, telephone interviews were held with residential care staff. Results: 153 people accounted for the 184 admissions. They had a mean age of 84 years and 69% were female. 61% came from hostels and 35% from nursing homes. They had a wide range of clinical problems and twice as many were admitted to medical than to surgical units. Their mean length of hospital stay was 7.9 days, 2.3 days higher than for non-same-day patients and was higher for hostel than for nursing home residents. All but two admissions were considered unavoidable though the provision of specialised care within residential care could have prevented a further 19 (10%) admissions. 96% of admissions resulted in survival to leave hospital and in 74%, people returned directly to their place of origin. At 3 months follow-up, a further 20% of the group had died while 5% were in hospital. In all, 14% of the original group were in a different long-term care facility while 56% were living at their former residence. Conclusions: People living in residential care are often hospitalised because of acute illness. In the vast majority of cases hospitalisation is both appropriate and unavoidable. Most did not require prolonged hospitalisation and were discharged alive, usually to their original residence. However, within 3 months many had died or had functionally declined. Strategies that prevent health breakdown in the residential care setting need to be developed and trialed.

Extending the Pillars of Social Policy Financing to Aged Care

Against the background of a recent resounding rejection of substantial increases in user contributions for funding long-term residential care in Australia, and especially of measures that could require realization of housing assets, this paper examines the scope for extending to long-term care the “pillars” approach to financing of retirement incomes and health care. The two latter areas are funded through pillars of general revenue, private insurance, social insurance by way of compulsory levies, and direct user contributions, whereas long-term care is financed only by a large pillar of general revenue and a smaller pillar of user contributions which are themselves drawn largely from transfer payments. Examination of the various pillars in each area suggests that there is limited scope for extending private insurance and user contributions in long-term care, but that there are several social policy grounds for incorporating a social insurance pillar. However, while discussion of social insurance options is growing in several quarters, the current political climate offers little prospect for the adoption of such a scheme.

Changing Patterns of Residential Care: A Report on the 1988 CIRI Survey of Children in Resident Care

PLACEMENT IN residential care continues to be an option for children who need substitute care. However, the number of children involved at any time is often uncertain, as a result of the diversity of agencies, government and nongovernment, that provide these services. The Children in Residential Institutions Program (CIRI) within the Special Education Program of the Department of Education, Employment and Training provides a unique means for identifying the number of children in residential care in Australia at any time. A national census of children in residential care was conducted in association with the CIRI Program in 1983 and repeated and replicated in 1988 in New South Wales and Victoria. Results showed that there had been changes in the numbers and category of children requiring care over the study period. There were fewer large congregate‐style residences and more small units and family group homes. The study highlights the need for collection of accurate data about the number of children in resi...