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  • Subject Name : Nursing

Clustered Domestic Residential Aged Care in Australia

The following case study analysis is about Amir, 78-year-old man suffering from poor health in level 2 home care package looking for an upgrade.

  • Accessing support and information

The Australian community-based aged care provides care for people aged 65 years or older which can be accessed are the Commonwealth Home Support Programme (CHSP) and Commonwealth Home and Community Care (HACC), The Home Care Packages Programme (Home Care) had Levels 1-2 (basic–moderate care needs), (i) CACPs - Home Care level 2, (ii) Extended Aged Care at Home (EACH) packages - Home Care level 4, and (iii) Extended Aged Care at Home Dementia (EACHD) Packages - Home Care level 4; whereas the Residential aged care provided “permanent accommodation and care” and “short-term accommodation and care” depending upon the situation (Australian Institute of Health and Welfare, 2018). 

The concept of “Advance care planning (ACP)” implemented by the government recognised by the National Palliative Care Strategy and Productivity Commission report focuses on individuals who are incapable of making decisions for themselves (Detering et al., 2019). Since Amir wants to stay at home, he can avail to the permanent residential aged care (PRAC) as it has subsidies from the government (Khadka et al., 2019). PRAC is only advised when all other options have exhausted which is the case with Amir (Khadka et al., 2019). Amir has to go online and access "My Aged Care" on-line portal established by the Australian government for availing any of the above-mentioned facilities (Khadka et al., 2019).

  • Design of aged care for adaptation

Aged care facilities are focusing on the concept of “Integrated care” for positive improvements of the individual’s health outcomes by making it much more accessible and comprehensive (Douglas et al., 2017). Doing such results in lesser hospitalizations, and decrease in mortality rates with a major focus being on the “Information and Communication Technology” (Douglas et al., 2017; Dyer et al., 2018). This improves their particular needs and can deliver their services by each individual (Douglas et al., 2017). The aged care facilities are focusing on care delivery systems which takes into their culture as well while planning, providing the resources for the elderly clients (Khadka et al., 2019). Some aged-care facilities implement the concept of “Domestic Model Care”, making the environment more like a home rather than a health care facility (Dyer et al., 2018). Following the national reform of "offering choice and flexibility for consumers", although is difficult, the aged care facilities are striving so the consumer can avail to greater choices while residing at the PRAC (Dyer et al., 2018). Although the cost of design for such cluster type caring facilities still needs more exploration, it is understood that through this leads to more satisfaction for the consumer, positive emotional and healthy outcomes (Dyer et al., 2018).

  • Evaluation of the aged care system that supports the continuum of care

National Cancer Institute, (2020) defines a continuum of care by "delivery of health care over a while. In patients with a disease, this covers all phases of illness from diagnosis to the end of life".

The Continuum Care aged care system has been chosen for evaluation. It has the necessary registration by the NDIS and approval for providing home care aged care services. Its home care services include Disability Support Services for people living in the community who have an NDIS Plan, Aged care services for people living in the community who have a Home Care package and Customers who are self-funded and require some day to day support (Continuum Care, 2020). It also has “Disability services which cater to “Household Tasks, Personal Care, Community Nursing, Life Skills Development, Daily Living Tasks and Community Activities” (Continuum Care, 2020). They also have “Support Specialist” for those who unable to do some task due to disability or age or recovering from illness. Their specialists include Registered Nurse, Domestic Assistant, and Support Worker (Continuum Care, 2020). For an aged care facility to be efficient at satisfying customers it is vital to have the services and Continuum Care fulfils all the requisites (Detering et al., 2019). Through their system they can deliver positive health outcome for the ageing patients and who are unable to take care of themselves (Detering et al., 2019).

  • Analysis of aged care to be patient care and efficient

If the aged-care facility aims to be efficient, then their approach should be centred on patient care which emphasizes of their individual “needs, preferences, and values of individuals “(Jorgensen et al., 2018). Jorgensen et al., (2018) stresses that to be the aged care facility main target should be offering more choices and control by the consumer demands. Providing aged care facilities also depends upon the location as the major city can fulfil most of the consumer demands whereas the aged care facilities located in remote regions might not be able to (Jorgensen et al., 2018). The same goes for people in low socio-economic demographic might not have access to all the facilities, although the government has provided subsidies for aged care costs (Jorgensen et al., 2018). Another negative observation is that increasing use of such services show that the consumer's health has been on the continuous decline and requires more and more care in various services (Jorgensen et al., 2018). The study analysed that for the consumers who had a high demand of "one-on-one companionship visits at home, assistance to attend community-based social activities" besides with domestic help showed better outcomes than those who didn't and (Jorgensen et al., 2018). Proper data to be collected can be hindered in the sense that other services used by the consumer are not reported to the aged care facility (Jorgensen et al., 2018). At times, they can prove to be proxy decision-makers for those clients whose clients who are not able to or are incapable of making them (Jorgensen et al., 2018).

As the more and more ageing population of Australia avail these services, the waiting time plays an important role (Visvanathan et al., 2019; Yu & Byles, 2020). Visvanathan et al. (2019) state that due to Australia's successful health department, particularly their aged care system, the ageing population has increased and that led to a significant economic burden. The waiting times significantly affect the mortality rate when the clients are waiting to transition from home care to residential care, the risk increasing after 30 days and even higher after waiting for 6 months (Visvanathan et al., 2019). Interventions if done are not known as of yet, to reduce the waiting time (Visvanathan et al., 2019). Those in longer waiting times, led to more hospital admissions and more emergency care, thus impacting the clients economically as well for hospital visitations (Visvanathan et al., 2019; Yu & Byles, 2020). Those who had longer waiting time were shown to be from a different cultural background, have continued to live with family support as different from the usual western norm (Visvanathan et al., 2019). The residential care placement risk is increased if the ageing person suffers from “delirium, falls and cancer” (Visvanathan et al., 2019). Simply funding for more health care is not the answer, more training for the while addressing the dementia is required as well, better policy initiatives, and in an increase in the health care workforce to address the growing needs (Visvanathan et al., 2019).

References for Amir Aged Care Case Study

Australian Institute of Health and Welfare. (2018). Older Australia at a Glance. Retrieved from https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance

Continuum Care. (2020). Home Care Support. Retrieved from: https://continuumcare.com.au/home-care-support/

Detering, K. M., Buck, K., Ruseckaite, R., Kelly, H., Sellars, M., Sinclair, C., ... & Nolte, L. (2019). Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: Multicentre audit study. BMJ Open9(1). DOI: 10.1136/bmjopen-2018-025255

Douglas, H. E., Georgiou, A., Tariq, A., Prgomet, M., Warland, M. A., Armour, M. P., & Westbrook, J. I. (2017). Implementing information and communication technology to support community aged care service integration: Lessons from an Australian aged care provider. International Journal of Integrated Care, 17(1). doi: 10.5334/ijic.2437

Dyer, S. M., Liu, E., Gnanamanickam, E. S., Milte, R., Easton, T., Harrison, S. L., ... & Crotty, M. (2018). Clustered domestic residential aged care in Australia: Fewer hospitalisations and better quality of life. Medical Journal of Australia208(10), 433-438. doi: 10.5694/mja17.00861

Jorgensen, M., Siette, J., Georgiou, A., Warland, A., & Westbrook, J. (2018). Modeling the association between home care service use and entry into residential aged care: A cohort study using routinely collected data. Journal of the American Medical Directors Association19(2), 117-121. https://doi.org/10.1016/j.jamda.2017.08.004

Khadka, J., Lang, C., Ratcliffe, J., Corlis, M., Wesselingh, S., Whitehead, C., & Inacio, M. (2019). Trends in the utilisation of aged care services in Australia, 2008–2016. BMC Geriatrics, 19(1), 213. doi:10.1186/s12877-019-1209-9

National Cancer Institute. (2020). Continuum of care. Retrieved from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/continuum-of-care

Visvanathan, R., Amare, A. T., Wesselingh, S., Hearn, R., McKechnie, S., Mussared, J., & Inacio, M. C. (2019). Prolonged wait time prior to entry to home care packages increases the risk of mortality and transition to permanent residential aged care services: findings from the Registry of Older South Australians (ROSA). The Journal of Nutrition, Health & Aging23(3), 271-280. Doi: https://doi.org/10.1007/s12603-018-1145-y

Yu, S., & Byles, J. (2020). Waiting times in aged care: What matters?. Australasian Journal on Ageing39(1), 48-55.doi: 10.1111/ajag.12665

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