Coproduction in practice : participatory action research to develop a model of community aged care

Coproduction has become synonymous with innovative approaches to public service delivery in European Union countries as well as in Australia. Coproduction has the potential to bring together individuals, communities, and organisations in a process to collaboratively develop new models and services which improve public services. Yet, Australian policy makers and practitioners who would like to deploy coproduction within the context of older adult social care can only draw on a handful of papers and reports that could guide implementation. This paper fills this gap by reporting on the implementation of a multi-stakeholder coproduction approach to the development of a consumer directed care model for older people with complex health issues. The paper describes and critically highlights methodological challenges encountered during the 12 month-long participatory action research phase of a larger project involving older people with complex care needs, their carers, and government and non-government stakeholders. The paper outlines key considerations regarding (1) the involvement of older people with complex needs, (2) collaboration with industry partners, (3) engagement of government representatives, and (4) reflects on implementing participatory research projects within a context of outsourcing and interlinked supply chains. While not all challenges encountered could be resolved, the coproduction approach was successful in bringing together a wide range of stakeholders with competing agendas in an iterative process geared to resolve a plethora of concerns raised by older people, carers and services providers. This paper provides an example for others seeking to use coproduction and participatory methods to provide person-centred care services for older people.

Impact of nursing information systems on residential care provision in an aged care provider

The challenge of an ageing population has placed a great pressure on the Australian aged care sector in the coming decades. Technology-enabled solutions such as health information systems (HIS) can be seen as a way to improve care quality, safety and process efficiency. Compared to the overall healthcare sector, the adoption of HIS in the aged care sector has been slower. One reason for this is that aged care providers are not well informed therefore not yet convinced of the positive impacts of technology solutions on their service provision. This paper reports findings from an evaluation of the impact of HIS adoption at an aged care provider in Victoria. The evaluation was conducted in two distinct areas, residential aged care and residential disability services. Overall, the findings show positive impacts of the system on individual work of the care staff and on service provision of the organisation as well as suggesting opportunities for improvement in later implementation stages. The evaluation will also inform other aged care and disability service providers of the benefits of HIS and useful lessons in adoption of technology solutions.

Information needs in community aged care

This paper focuses on the information needs and behaviours of senior citizens and their carers in the community. Two case studies concerning elderly stroke patients and their carers are described and discussed. Analysis of the case study data reveals a number of themes including the actual information needs and information behaviours of the senior citizens, the importance of proxy information seekers and advocates and the need for usable, accessible and useful tool to support the needs of care recipients. A preliminary framework is developed that highlights important aspects of supporting the information needs of care recipients and carers in community aged care. Finally we suggest opportunities for technology interventions that address various information needs of senior citizens in the community.

Aged care, Warrnambool and Bendigo, 2021 ,estimating land-use, connectivity

Ratios which correlate aged care places with Land-use requirements are developed by analysing the existing aged care facilities in the regional Victorian Local Government Areas of Greater Bendigo and Warrnambool. These ratios are used in conjunction with the government's population based measures to model scenarios of future aged care infrastructure requirements for Greater Bendigo and Warrnambool. Strategies correlating additional residential aged care facilities with at-home based aged care are explored using a Land-use and accessibility matrix governed by size and configuration. Variations in these two aspects appear to have a significant influence on location options for future facilities as well as case load demands and staffing requirements for community support teams.

An evaluation of a national program to implement the cornell scale for depression in dementia into routine practice in aged care facilities

Background: Screening tools have been recommended for use in aged care to improve the detection and treatment of depression. This study aimed to evaluate the impact of a program for the routine implementation of the Cornell Scale for Depression in Dementia in Australian facilities, to determine whether use of the instrument by nurses led to further monitoring of depressive symptoms, medical referral, and changes in treatments prescribed for depression.
Methods: A file review was completed for 412 participants out of a total of 867 older people (47.5%) who resided in ten aged care facilities. The review examined Cornell Scale assessment data, medication charts, medical history, nursing progress notes, and resident care plans. Nursing staff who administered the Cornell Scale to each participant were also interviewed, and ten facilitymanagers took part in an interview to determine barriers to the effective implementation of the instrument.
Results: The Cornell Scale had been administered to 46.8% of the sample in the previous 12 months, with 25% of these participants scoring 9–13 and 27% scoring 14 and above. Less than one third of the residents with high scores were monitored by the staff following the assessment. Only 18% of residents with high scores were referred for further assessment of depression, while 10% received a treatment change.
Conclusions: The absence of a protocol for responding to high Cornell Scale scores limited the potential of this program to result in widespread improved treatment of depressed older people. The use of the Cornell Scale by aged care nurses with limited training raised concern.

Intentions to quit work among care staff working in the aged care sector

Purpose of the Study: The aged care industry experiences high rates of staff turnover. Staff turnover has significant implications for the quality of care provided to care recipients and the financial costs to care agencies. In this study, we applied a model of intention to quit to identify the contextual and personal factors that shape aged care staff’s intention to quit.

Design and Methods: A sample of 208 aged care staff, including nurses, personal care assistants, allied health professionals, and managers completed a self-report questionnaire. The questionnaire assessed intention to quit, organizational commitment, job satisfaction, self-esteem, stressors, stress, and supervisor support.

Results: The findings largely supported the model. Specifically, job commitment, job satisfaction, and work stressors directly influenced intentions to quit, although work stressors and supervisor support demonstrated numerous indirect associations on quitting intentions.

Implications: The findings suggest that aged care service providers can modify aged care workers’ intentions to quit by reducing job stressors and increasing supervisor support.

End-of-life care for aged care residents presenting to emergency departments

Background: The number of patients from Aged Care presenting to acute care is increasing, many of whom have a life limiting illness.

Aims: To identify differences in relation to Aged Care Residents presenting to Emergency departments who died during a hospital admission compared to those who were referred to the hospital based palliative care.

Methods: Review of a stratified random sample of 90 Aged Care residents transferred to acute care who died during admission in 2009; half the sample received palliative care. Comparisons were made with regard to age; gender; co-morbidities; symptoms, investigations and active treatment; prior admissions and costs.

Results: The median age of patients was 87.5 years, 61% were female and 38% had three or more admissions in the year prior to death. Patients with a length of stay of four or more days were 2.98 times (CI, 95%:1.11-8.03) and patients with agitation were 3.08 (CI 95%:1.10- 8.64) times more likely to be referred to palliative care. Patients who received palliative care had significantly fewer investigations or active treatment in the 24 hours prior to their death (p< 0.01) and palliated patients had significantly lower average costs per day of admission ($1022, SD=$441) compared to those who were not palliated ($ 831; SD= $ 1041) (p< 0.001).

Discussion: Our study indicates there is a difference between dying patients who received palliative care compared to those who did not in an acute care setting. Further research into the outcomes of patients discharged back to Aged Care facilities for palliative care warrants investigation.

Communication pathways in community aged care: an Australian study

Background:
Health and social care practitioners collaborate in discharge planning for older people. Difficulties securing timely and quality discharge information and unclear role boundaries can be challenging. There are limited reports in the literature describing community-based practitioners' roles communicating client information.

Aim:
To describe the roles of community-based practitioners in communication of older clients' information in an Australian context.

Design:
A descriptive and exploratory qualitative research design was applied.

Methods:
Four focus groups were conducted in 2009 with a small sample (n = 16) of district nurses, practice nurses and aged care case managers.

Results:
All participants described communication as a core characteristic of their role focused on minimising risks for older people. Participants valued dialogue with other health and social care providers in real time with an emphasis on telephone communication, face-to-face meetings, and case conferences. Telephone communication was considered important where there was an urgent need to problem solve. Written communication was noted as less effective.

Conclusions:
There is an increasing need for stronger models of communication in community-based settings to facilitate safe, efficient and sustainable health and social outcomes for older people.

Implications for practice:
There is limited available research with this focus to guide practice. Findings from this exploratory study indicate a number of important areas for further research: (i) to understand how communication feedback systems and pathways between community and inpatient providers could improve information exchange and (ii) to describe community nurses' roles in communication and medication risks for older people.