In Australia the frail aged can be supported in their own homes or in institutional settings. The latter include retirement villages which may provide minimal support such as security, social activities and some other services. RACFs (Residential AgedCare Facilities) or nursing homes offer two levels of care – low care for residents capable of some independence and high care for people needing help with many of the basic activities of daily living. The latter includes dementia wards. People needing support may also receive services in their own homes. RACFs and some agedcareservices in people‟s homes funded mostly by the federal Department of Health and Ageing subject to assessment of the individual. RACFs can be one of several owned by a large organization or can be independent. They can be for profit or not-for-profit. Major for profit operators include BUPA and Tricare; NFP includes Blue Care, RSL Care, Baptist Care, Lutheran Care and Spiritus.
because of our inability to account for potential multiple entries into the same service by the same person as our data does not include individual identifiers. While it is un- likely that this would occur in those accessing home care, permanent residential agedcare, and transition care, it is possible for the respite care estimates. Finally, the inci- dence rates of service admission were calculated based on the proportion of the Australian population aged 65 years old and older, but not all Australians users of agedcareservices were included in this evaluation. For example, in- digenous people may access age careservices when they are 50 years of older and under certain circumstances younger people with disabilities (50–65 years ATSI are < 0.3% of the total population receiving agedcare). How- ever, as the vast majority of agedcare recipients are aged 65 years and over and the main focus of this study.
Mapping spatio-temporal changes in near real time can assist in the successful planning and management of agedcare programs. Accurate information on the location of agedcareservices centres and mapping the special needs of clients and their service needs may assist in monitoring access to services and assist in identifying areas where there are logistic challenges for accessing services to meet needs. GIT can also identifying migrations of aged people and of the cohorts of the population who are likely to be the next wave of clients for agedcareservices.
the data sets precludes linking data using either of these approaches. However, a range of other data items is com- mon to both data sets, and so the challenge is to deter- mine whether there is sufficient information on the two data sets to allow reliable record linkage to generate a linked database on individuals who move from hospital to the residential care sector which could then be used for analysis of patterns of movements. Such anonymous record linkage, without access to name information–ano- nymised or otherwise–or a unique person identifier, has been used successfully before in a number of scenarios [29-32]. These studies commonly include matching by date of birth and sex within region, in conjunction with study-specific non-name variables.
Many older adults express a desire to remain living in their own homes for as long as possible, and to stay con- nected as contributing members of their communities . Targeted community agedcareservices are a central way of supporting older adults to achieve their health goals, enabling them to be more independent within their own homes and the community. However, commu- nity agedcare service provision has tended to focus on meeting specific physical needs of older adults rather than targeting strategies which may be effective in im- proving their social participation and reducing loneliness . International studies have demonstrated that consid- eration of psychosocial needs, such as participation in meaningful activities, as part of community agedcare assessment and service provision can enhance choice, improve quality of life (QoL) and reduce carer burden [7, 8]. High levels of social participation among community-dwelling older adults are associated with lower levels of psychological distress [9–17], greater hap- piness and satisfaction with life , higher self-rated health [18, 19], better physical function , lower risk of future dependence for Activities of Daily Living (ADLs) , and reduced mortality . Social participa- tion also generates societal benefits through older adults volunteering and community contributions to neighbour- hood associations, religious groups or non-governmental organisations .
The negative image of agedcare (see Section 4.1) and the problems with recruitment and retention in the sector are long standing issues. A succession of studies has been undertaken addressing the issues around creating an appropriate agedcare workforce culminating in the $7.2 million major review of pricing (led by an economist), which was commissioned by the Commonwealth Government to examine the longer-term prospects of residential agedcareservices with particular respect to funding, performance improvement and financing (Hogan 2004). Among the many issues raised in his report, Hogan (2004) urged much greater efficiencies in agedcare, pointing to problems with the viability of the sector. However, his comments on efficiency in the sector have since raised concerns about increasing commercial productivity at the cost of the length of time nurses spend with resident. This report once again identified the shortage of trained staff, which was undermining the capacity of the sector to provide appropriate quality care to older Australians, and recommended that the Government should refocus and expand its support for the education and training of agedcare nurses and care workers.
The Trend Towards Community Care and “Ageing in Place”: Prior to 1985, the majority of Australian agedcare programs focused on the provision of institutional care in nursing homes and hostels. In response to the increasing cost and quality pressures on the provision of residential care, the Federal government initiated the National Home and Community Care Program in 1985 to cater for agedcareservices within the home. Since that time, there has been a steady move away from residential care toward providing agedcare in the home to maximise the time that the older frail individual can remain in their home, or “age in place”. While the residential care sector still plays a major role in the aged and community care sector, there is every indication that the trend towards community care will continue, as evidenced by the focus on community care options in recent documents looking at the future of agedcare service provision in Australia (ACSA, 2002b; Myer Foundation, 2002).
Abstract: The expectations of adult children about their elderly parents regarding their care provision was surveyed. We found that the needs and expectations re- garding their elderly parents included better information on entitlements of their parents, how to access relevant agedcareservices, the challenges of remotely dealing with dementia and depression of their parents, accessing medical and non- medical services and access to respite care. The aim was to identify needs that ICTs could potential to assist with. While the majority of respondents (67.2%) stated that they were satisfied or very satisfied with the frequency of contact with their elderly parent(s), they also cited logistical/transport difficulties, lack of time and stress as potential barriers in being in regular contact with their parents. The responses also indicated a high level of interest in a service that could act as a case manager to assist the adult child in discharging their responsibilities, manage ac- cess to services and to monitor the well-being of the parent. There is a need for further research to explore how this might be accomplished, whether such a ser- vice was viable and what funding models could be applied.
Declaration of Sources of Funding Clinical components of this study were funded by Goodwin AgedCareServices. NM is undertaking a PhD funded by a Commonwealth scholarship: the Australian Government Research Training Program Stipend Scholarship. Trial registration This study reports findings associated with the secondary outcome listed under a broader trial retrospectively registered under the Australian New Zealand Clinical Trials Register, reference number: ACTRN12617001506381 (registered: 25/10/2017) Universal trial number U1111-1200-3611.
A picture of the future can be found in projects across the ageing countries. In Korea and Japan there are robotics and intelligent devices. In the USA there is CAST (Center for Aging Services Technologies - www.agingtech.com) and associated laboratories that are researching a wide variety of approaches and technologies to support both active ageing and agedcare. In Florence, Italy an operator of a chain of residential and community-based agedcare, Montedomini AgedCareServices, operates a home telehealth system that links frail elderly in their own homes (Abbamondi AL, 2005). The service provides security services, medication reminders, and video-call links through a set-top box connected to the client’s television. The home technology environments are managed remotely by Call Centre staff. In Australia interest in this research field is evident in projects across several universities. In addition there has been the establishment of AgedCare Informatics Australia (within the Health Informatics Association of Australia), an ICT group within the ARC-NHMRC Research Network for Healthy Ageing and the annual AgedCare Informatics Conference (www.hisa.org.au) as means of linking researchers in this field and promoting informatics for ageing and agedcare.
In short, the current arrangements, while relatively effective in likely providing for equitable access to aged- careservices, achieve that goal through a complex tangle of quantitative restrictions that impedes supply flexibility and limits competition. The lack of competition and the desire to limit the Commonwealth’s fiscal exposure then give rise to price controls, which though extensive are of very differ- ing degrees of effectiveness. Consumers face restricted (and distorted) choices in terms of the range of care available, and charges that are often difficult to understand as a result of the interaction of complex prices with even more complex income and assets tests. Recent changes to policy do move broadly in the right direction in addressing these issues, but there remains a need for more comprehensive reform, which by its nature will take some years to devise and effect.
In 2015, the Australian Bureau of Statistics identified that 94.8% of older people lived in households . This highlights Australia’s federal government policy of ‘ageing in place ’ , wherein the objective is to maintain older people in the community for as long as possible, whilst reducing morbidity, hospitalisation and admission to agedcare ser- vices . Ageing in place aims to provide support for older people so that they can live where they choose for as long as they can. As the population of Australia ages, it is crit- ical that older adults, their families, healthcare providers and healthcare systems are equipped to deal with the challenges of cultural diversity and heterogeneity in ageing. Concomitantly, arrangements for the delivery of Australian agedcareservices have changed dramatically in recent times .
process, and outcome indicators. Most of the studies used standardized questionnaires or instruments to col- lect data on quality indicators, either routinely applied at a state level for mandatory reasons (MDS, Victorian Public Sector Residential AgedCareServices [VPSRACS]), or implemented as an annual measure- ment of malnutrition prevalence and structural quality indicators of nutritional care in the NHs that voluntarily decided to participate to the study (LPZ). As for the out- comes, different indicators were taken into account. However, weight loss was always included, although dif- ferent combinations of time periods and cut-offs were considered for each instrument. It was evident that no consensus exists on the sets of indicators to be used, es- pecially outcome indicators, even though only a few in- struments were used to collect data. Nevertheless, according to our findings, the presence of nutritional screening and its inclusion in the care file, the availabil- ity and use of protocols on malnutrition prevention and treatment, mealtime assistance, and the use of nutri- tional treatment/supplements, all appear to be relevant indicators for nutritional care quality assessment. In any case, studies aimed at testing the reliability and validity of these indicators, as well as the outcome indicators, need to be developed in order to identify the best set of indicators for describing the quality of nutritional care in NHs. This is also in agreement with statements of other authors [45, 46].
Australia, similar to other developed countries, is facing unprecedented challenges to meet the growing health- care needs of an aging population. It is predicted that by 2050, upwards of 3.5,000,000 Australians will be accessing agedcareservices annually. This growth will occur alongside a forecast health workforce shortage and a decreasing number of primary care physicians (PCP) visiting AgedCare Facilities (ACFs) . In an ef- fort to meet this increased demand, different healthcare service delivery models are emerging that challenge traditional professional health boundaries. Such models include the emergence of the nurse practitioner (NP), who is endorsed to provide specialised healthcare ser- vices such as prescribing medications, referral and or- dering of specific diagnostic investigations . The title of NP is protected by law, has rigorous accreditation processes and can only be used by those educated at Masters level and endorsed by the national registration body .
together at a site to ensure effective agedcare is delivered, so the agedcare site must be the unit of randomisation. The study is set in urban and rural residential and com- munity agedcareservices within two states in Australia, New South Wales (NSW) and the Australian Capital Ter- ritory (ACT), over three years. The participating research partner is one of the largest agedcare service providers on the eastern seaboard of Australia, employing over 4,000 staff across NSW and the ACT. The partner organisation recognised the importance of providing a work environ- ment that optimised staff well-being and increased cap- acity for high quality, safe care. Clinical leadership for middle management was identified as an area of improve- ment for the organisation. The organisation agreed to col- laborate with the research team in researching these concepts. The collaboration is designed to provide the or- ganisation with the opportunity to build staff capacity in these specific research areas through education/training and practice development. Mutual partnership goals in- clude development of leadership strategies and policies that address workforce recruitment and retention in the agedcare sector, which are both considered to be key to progressing high-quality careservices.
Several selective prevention approaches are available to enhance protective factors or provide specific support for individuals and groups at risk of health problems. It has been noted that children and young people in public care have an increased risk of emotional or behavioural problems than the general population: 45% of children aged five to 17 in public care in England have a diagnosable mental disorder (Meltzer et al 2008). A selective intervention for this vulnerable group might be the provision of independent living programmes designed to provide young people leaving the care setting with social skills to limit any disadvantage and assist successful transition into adulthood. A review of such programmes indicated that they may improve education, employment and housing- related outcomes (Donkoh et al 2006).
The age structure of Australia has been gradually changing from a pyramid shape in the past with large numbers in younger aged groups and few people reaching old age to more of a column or coffin shape with few people dying before reaching old age. 1 Life expectancy at birth of Australia in 2003 was 78 for males and 83 for females with a continuing reduction in mortality rates across younger age groups. As the population continues to age the incidence of dramatic disability restriction and hospital utilization spirals upward. 2 In addition the rapid increase of percentages of consumers aged 65 and over will result in the substantial gap between the availability of care providers and demand for agedcare in the future. 3 There is a world-side shortage in some areas of professional carers such as nurses and there is no longer the availability of informal carers for elderly parents or others requiring support. This means we need alternative approaches to providing appropriate health and agedcare for the elderly people at present as well as in the future.
careservices remains a call for action. Data collected over the past decades demonstrates the improvements that have been made to the oral health status of older adults living in Australia. Today, new cohorts of older adults are more likely to keep their natural teeth. This creates challenges that are completely different from the past. Additionally, oral cancer is more common at older ages, and there is strong evidence about the general health consequences of neglected oral hygiene (e.g., aspiration pneumonia).
the community, more effort and resources should be allo- cated to community health services. Studies show that older adults with dementia and their family members have reported unmet needs and suffering (https://www.demen- tiafriends.org.uk/). For example, there is a need to improve the education of family physicians in the early detection of dementia and the assessment of cognitive and behavioral deterioration. There is also a need for much more compre- hensive geriatric evaluation clinics and home care for people with dementia. Community-based palliative care for dementia needs to be developed since studies have shown that people with advanced dementia suffer from pain, skin breakdown and other symptoms [17, 21]. It is anticipated that the convergence of a top-down directive, and an in- crease in bottom-up programs will lead to the development of better community – based palliative care for dementia. At the same time, studies are needed to assess the quality of these programs to stimulate new bottom-up initiatives and facilitate decisions for future planning.
Abstract: This study aimed to establish compre- hensive estimates of the cost of fall-related injury among older people in NSW. A health service utilisation approach was used to estimate the cost of hospital treatment, residential care and ambu- lance transport. Other costs were estimated by deriving ratios of inpatient costs to other services from the literature. In the 2006–07 financial year, 251 000 (27%) of older people fell at least once and suffered, in total, an estimated 507 000 falls. An estimated 143 000 medically treated fall- related injuries among older people resulted in lifetime treatment costs of $558.5 million. Although only 18% of these injuries resulted in hospital admission, the cost of care associated with these cases accounted for 84.5% of the total cost. The cost of fall-related injury among older people in NSW in 2006–07 is a significant increase over earlier estimates and underscores the urgent need for effective preventive efforts across the state.