W10 Residential Aged Care

Why is aged care complex?

• multiple co-morbidities

• challenging behaviours

• complex needs

• proportion of healthcare professionals

• end of life issues

• issues of capacity and consent

• elder abuse

behavioural and psychological symptoms of dementia

• delusions

• irritability

• hallucinations

• agitation/aggression

• depression

• anxiety

• euphoria

• apathy

• disinhibition

• aberrant motor activity

• night-time behavioural disturbances

• appetite and eating abnormalities

6 qualities for working in aged care

1. empathy

2. patience

3. flexibility

4. advocacy

5. problem-solving

6. compassion

what rights do people receiving aged care services have

• personal privacy

• involvement in decision making

• treated with dignity and respect

• good quality care that meets their needs

• full and effective use of your personal, civil, legal and consumers rights

• complain and take steps to sort out any problems

• advocacy support

what are some of the implications from the new aged care act for speech pathology practice

• greater access to allied health including speech pathology for older people, regardless of whether they live at home or at residential aged care

• insufficient workers with the appropriate skill mix and with the appropriate training to match to the care needs of older people, or with appropriate level of renumeration

• the aged care system did not adequately cater to people’s culture, background and life experiences

6 principles that exemplify culturally safe aged care

1. respecting Aboriginal life, traditions and living culture

2. create and maintain aboriginal friendly spaced

3. Provide buildings that meet Aboriginal Elders’ and their communities’ needs

4. Employ Aboriginal Staff

5. All Aged care staff work towards cultural competence

6. be an advocate for and with Aboriginal elders and their communities

what are the types of aged care

1. Home level support

• Commonwealth home support program

• home care packages

2. Residential care

• can be permanent of short term (respite)

3. Short term care

• after hospital/transition care

• restorative care

• respite care

who is responsible for assessing eligibility and level of support for care

Aged Care Assessment Team (ACAT)

How is aged care funded at a care facility

the Australian national aged care classification (AN-ACC) care funding model

1. Base care tariff (fixed funding)

2. AN-ACC classification (variable funding)

who assesses using the AN-ACC Assessment Tool and what does this consider

• independent assessors separate to the aged care provider

• the assessment tool considers physical ability, cognitive ability, behaviour, mental ability

• usually nurses, physiotherapists, occupational therapists

what are the providers responsible for

• receive the funding

• decide how best to meet the care needs of residents

• ensuring allied health treatments deemed most beneficial to the resident

how is aged care quality maintained

• the aged care quality and safety commission

• the independent health and aged care pricing authority (IHACPA)

• the department of Health

what is the role of the slp in aged care

• contribute to assessment of decision-making capacity

• facilitation of active decision making for older people with communication support needs

• mealtime support needs associated with dysphagia

what are mealtime support needs associated with dysphagia in aged care

• informing alternative feeding methods and end of life decisions

• education, advocacy and counselling on the risks and benefits of alternative feeding methods

what should be considered in terms of communication in aged care

• reducing environmental, physical and psychological barriers to communication

• communication enhancement programs - educating staff

• mealtimes are a primary opportunity for social interaction for older people

how is aged care according to the speech pathology australia professional standards

• Professional Standard 1.2: comply with legislation, standards, policies and protocols

• Professional Standard 1.7 & 3.1: advocate for optimal communication and swallowing develop shared understanding of speech pathology

• Professional Standard 1.4: collaborate with individuals, their supports, our colleagues and the community

• Professional Standard 3.4: plan speech pathology intervention or service response

• Professional Standards 1.3: Provide safe and quality services

• Professional Standard 1.5: maintain high standards of communication, information sharing and record keeping

• Professional Standard 1.1: Provide ethical and evidence-based practice

• Professional Standard 1.6: Consider the needs of the individuals and communication in clinical decision-making practice

MESSAGE strategies

Maximise attnetion

watch your Expression and body language

keep it Simple

Support the conversation

Assist with visual Aids

Get their message

Encourage and Engage in communication

what can be used for intervention in aged care

• MESSAGE strategies

• talking mats

• spaced retrieval

• reminiscence therapy

• memory/chat book

• groups

how can environmental modifications impact the aged care environment

• reduce background noise

• avoid having competing noises at once

• calming background music may be appropriate

• remove clutter and unnecessary items

• stay still why you are talking

• maintain regular routines and environments

• have quiet rooms or spaced for important discussion

Communication audit

• investigating the aged care environment in terms of physical environment and social factors

• work with other professionals e.g. OT

mealtime management and dementia (types of considerations)

• showing the impact that different possible cognitive difficulties, social difficulties and behavioural difficulties they may have

• reduced level of consciousness

• positioning

• pacing

mealtime positioning in aged care that is needed for educatin nursing stagg

• sitting as upright asap

• body in the middle

• facing the front

• avoid feeding in bed if possible

• use pillows/blankets/towerls to support

pacing in aged care

• watch the resident

• make sure the swallow happens

• may need more than one swallow

• breathing should return to normal

• get to know the resident’s eating pace

• may need high calorie diet if slow

• try to feed at the resident’s pace

appropriate aids for educating nursing staff

• dentures

• glasses

• hearing aids

considering reduced levels of consciousness to educate nursing staff

• only feed when they are alert enough

• need to use something cold before meals

• show the resident the food

• talk about what you are doing

• give all you attention to the resident you are feeding

• limit distractions

hearing loss prevalence and co-occurring conditions

rate of hearing loss increases as age increases

higher in males than females

co-occur with dementia and vision impairment

what are effects of poorly managed sensory impairment

• exacerbated impact of cognitive impairment

• reduced quality of life

• social isolation

• behavioural and psychological disturbances

• increased use of pharmaceutical restraint

• reduced function, higher dependence

• greater care burden

is hearing loss in aged care setting taken note of

• there was a high percentage of people were living with a hearing impairment undetected and untreated

• under-usage of hearing aids

• staff lack training

• no access to on-site hearing professionals

impact of hearing loss in aged care facilities

• hearing loss was associated with lower levels of wellbeing variables and quality of life e.g. social engagement and mood

• facilitators of communication were insufficient e.g. sound absorbent materials, quiet/private places for conversation, optimal grouping of furniture

• staff did not always practise best communication behaviours

staff challenges in aged care

• high workload demands and high rate of staff turnover

• underestimate the extent of hearing problems in the residents

• limited knowledge about hearing and focus on physical care with little time to talk to residents

how does the physical and social environment provide challenges to hearing loss

• lack of privacy

• high reverberation levels

• high levels of glare

• few opportunities to talk

• few communication partners

• limited topics of conversation and reasons to talk

current audiology services in Australian aged care facilities

• residents are often seen by many hearing care providers

• the same as for community-based older people

• does not look at the context

perceptions and prevelance of hearing aids

• take-up rates of hearing aid fitting are low

• use of hearing aids by those who accept them is poor

• people who are new to hearing aids are often not used to them and have higher dependence on others for hearing aid management

barriers to hearing aid use - why may staff not be as committed to using their hearing aids accurately

• complexity of residents’ conditions

• lack of system commitment to aid use

• inappropriate delegation and care procedures

• lack of social support

• lack of staff knowledge

• aid design and fit issues

barriers to effective utilization of hearing aids

• major reason is neglect of the issue

• often those who used them had problems with maintenance and taking care of the device

• many staff members had not received any training in the use of the device

staff complaints about hearing aids

• difficult to manage

• not clear how to turn on/off - there are many different types

• don’t know how to change volume

• aids too inconspicuous and easy to lose

• aids spend most of the time not working or not in the ear