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Background: As mobility in the elderly declines, dependence on care increases, and that care involves preventing pressure ulcers (PUs). PUs may become colonized with methicillinresistant Staphylococcus aureus, causing cross-infection problems and leading to sepsis and death. Aims and Objectives: The aim of this paper was to examine the prevalence of methicillin-resistant S. aureus in residents with PUs and consider regulations. Materials and Methods: A retrospective review of 80 records of residents aged ≥65 years from eight residential aged care facilities (RACFs) in Australia was undertaken. Records were reviewed for sex, age at death, source of admission, Stage of PU, and colonization with methicillin-resistant S. aureus. Results: A third of residents, 34% (95% confidence interval [CI] 25%-44%, 27/80), had PUs in the last week of life. Of residents admitted from hospital 13% (95% CI 9%-32%, 7/40) had PUs. Most (63%, 95% CI 44-78%, 17/27) residents with a PU had been admitted from hospital, and most PUs (78%, 95% CI 59-89%, 21/27) were open wounds, Stages 2-4. Half of all residents with a PU (48%, 95% CI 30-67%, 13/27) were colonized with methicillin-resistant S. aureus, and a third of residents with Stages 2-4 PUs (31%, 95% CI 13-58%, 4/13) were colonized with methicillin-resistant S. aureus. Conclusion: Nearly half of all PUs were colonized with methicillin-resistant S. aureus, suggesting PUs may be a reservoir for methicillin-resistant S. aureus. Regulations that could reduce PUs in RACFs "an air mattress appropriate to each care recipient's condition" are not being utilized. If PUs were prevented, reservoirs for methicillin-resistant S. aureus would be eradicated. [ABSTRACT FROM AUTHOR]

Objectives: This paper describes the rationale for and development of an innovative mental health service for people aged over 65 years living in Northern and Eastern Melbourne, Victoria, Australia. Conclusion: The Healthy Ageing Service (HAS) was established in July 2020 to provide care for people aged over 65 years experiencing mild-to-moderate mental health concerns. It embraces a prevention and early intervention model of care. It provides primary consultation and brief intervention, secondary consultation, and capacity building to the primary healthcare sector. This innovative service is a Commonwealth-funded partnership between two tertiary mental health service providers that incorporates the recommendations from two major Royal Commissions. It demonstrates a service that acts as a bridge between primary and specialist mental health care, thereby extending mental health services to target the 'missing middle' and is potentially a model for mental health service provision throughout Victoria and Australia. [ABSTRACT FROM AUTHOR]

Objective: As governments grapple with ageing populations, there is a need to understand more about the aged care workforce and how it is managed. Methods: We undertook a scoping review according to the Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) guidelines. Scopus and PubMed were used to identify papers published between 2010 and 2020. We mapped the breadth and scale of the evidence base according to the QuInnE indicators of job quality. Results: Out of 642 titles and abstracts that were screened, 122 were selected. Outcomes were measured across a range of domains, including wages, employment quality, education and training, working conditions, work/life balance and consultative participation and collective representation. These were distributed unevenly, revealing evidence gaps. Conclusions: We identified significant knowledge gaps regarding Australia's aged care workforce at a time when the sector is coming under fresh scrutiny and projections indicate that it will face critical labour shortfalls going forward. [ABSTRACT FROM AUTHOR]

Objective: The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods: A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results: The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8–43.3], vs 37.8% [37.6–38.0]), unplanned hospitalisation (39.8% [39.6–40.1] vs 33.4% [33.2–33.6]) and potentially preventable hospitalisation (11.8% [11.6–12.0] vs 8.2% [8.1–8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions: While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency. What is known about the topic? Unplanned hospitalisations and emergency department presentations are frequent and burdensome for older people receiving long-term aged care. What does this paper add? While unplanned hospitalisations and emergency department presentations were high in all people receiving long-term care, these events were higher in people receiving home care packages than those in residential aged care. What are the implications for practitioners? Further efforts to address the high unplanned hospitalisations and emergency department presentations experienced by the increasing number of older adults accessing home care packages are required to allow this population to remain at home successfully. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

In Australia, numerous reviews and inquiries have documented concerns about inadequate access to, and the quality of, aged care. Despite those concerns, research is yet to appraise fully how care needs are assessed, prioritised, and met or left unmet. This paper asks two interrelated questions: (1) How should we conceptualise and measure unmet care need and care inequalities among older people? (2) What are the policy parameters for assessing needs, prioritising access to support and monitoring quality in aged care in Australia? Key insights from academic literature are used to critically review Australian policy documents describing rights, assessments, prioritisation, quality standards and performance indicators for the aged care sector. Using the concepts of care inequalities and care poverty, the paper develops a framework for understanding and measuring needs and unmet needs in aged care, and for encompassing fundamental and valued aspects of life for older people, their carers and their care network. The paper argues that the concept of care poverty opens the space to discuss what level of unmet need and inequality in access to aged care in any society may be considered intolerable. [ABSTRACT FROM AUTHOR]

Healthy ageing refers to the development and maintenance of the functional ability of ageing individuals. Aged care nurses provide nursing care to elderly individuals and usually work in aged care residential facilities, nursing homes, home care services, and/or hospital departments. The registered nurse working in the aged care sector has several important roles. Key roles cover both therapeutic and preventative paradigms, as discussed in this paper. The aged care nurse is also "tasked with" holistic patient-centred care and the promotion of healthy ageing via advocacy and sociocultural roles. This paper examined, described, and analysed the multifaceted role of an aged care nurse from an Australian perspective. We conducted meticulous searches using PubMed, Google Scholar, government guidelines, authoritative body regulations, quality control guidelines, and government portals pertaining to aged care nursing in Australia. This paper relied upon the information garnered from publications, reports, and guidelines resulting from these searches and analyses. Multiple aspects of healthy ageing and holistic aged care nursing are discussed. The key roles of the aged care nurse are enumerated next, in accordance with the code of conduct from the Nursing and Midwifery Board of Australia (NMBA). The NMBA promotes evidence-based, culturally sensitive, consultative, holistic aged care clinical practice that includes input from care recipients, their decision makers, and/or their health care providers. The difficult issue of loneliness is discussed with strategies to ameliorate aspects of this. Good social networks, community interactions, meaningful friendships, and participation in personalised spiritual/religious practices improve the quality of aged care. The key topic of elder abuse and its forms are discussed apropos of aged care nursing. Healthy ageing is promoted by identifying and reporting elder abuse at the earliest. Current Australian law and recent federal legislation changes pertaining to aged care nursing are discussed next. As a result of these legislation changes, several new quality control imperatives (for aged care organisations/facilities) under the Aged Care Quality and Safety Commission (ACQSC) have been implemented. Residential and flexible aged care providers should now have robust ongoing documentation and a well-developed behaviour support plan (BSP) for each care recipient who currently requires or may require restrictive practices, which must be reported under the new serious incident reporting scheme (SIRS). Various strategies to promote healthy ageing and approaches to communicate effectively with aged care recipients are also discussed. Healthy ageing is promoted when age care recipients are empowered with making their own autonomous choices in "major and minor" aspects of life. Finally, approaches to optimise quality aged care nursing care are discussed. The Roper–Logan–Tierney model is one of the models used to assess and optimise nursing care. This is premised on the capability of an ageing individual to accomplish 12 basic activities of daily living. [ABSTRACT FROM AUTHOR]

"Forgotten Australians" are the estimated half a million children who were placed in institutional care in Australia from the 1920s to the 1980s. Increasing numbers are entering older age but many are poorly positioned to age well and with the supports they need. This is often because the lasting effects of childhood institutional care have contributed to poor housing outcomes, including housing insecurity, reliance on social housing, prevalence of rental stress and experiences of homelessness. This paper presents a review of the evidence on the housing experiences and outcomes of people who spent time in childhood institutional care. The evidence review was complemented by qualitative interviews with community service practitioners and representatives of advocacy groups. Based on the prior evidence and fieldwork, we identify data and service gaps that are likely to undermine the capacity of the housing and aged care sectors to improve the care and supports available for Forgotten Australians. We suggest potential improvements to service delivery for people who experienced institutional care as children and directions for further research. This paper contributes to a stronger evidence base around the housing and care needs of Forgotten Australians in mid‐ and later life. [ABSTRACT FROM AUTHOR]

OBJECTIVES AND IMPORTANCE OF STUDY The objective of this systematic review of the literature was to examine the evidence relating to consumer-directed care (CDC) in the aged care environment. CDC entails providing individuals with the option of choice and flexibility in their care, to empower aged care recipients with autonomous decisions over their healthcare choices. Additionally, the researchers found evidence relating to the vulnerability of users of aged care services and the lack of understanding towards a true consumer-oriented approach which was highlighted during the Royal Commission into Aged Care Safety and Quality. STUDY TYPE AND METHOD The research team used the PRISMA Method to review the available literature systematically. This qualitative review of the literature on consumer choice in the aged and social care sectors assessed sixteen high-quality research papers and identified themes that emerged to promote authentic consumer voice in aged care services. These articles provided insight into what aged care providers require to increase transparency and facilitate effective, meaningful consumer choice. RESULTS Six themes emerged from the literature reviewed: Informed Choice, See Me Hear Me, Funding My Choices, My Choice My Way, Policy, and Know Me, Include Me. The authors found significant challenges to authentic consumer voice in terms of reliable information, complex, inflexible service provision, and a trusted and skilled carer workforce. CONCLUSION Authentic consumer choice requires collaboratively designed care plans with consumers, integrating their care-related preferences and values. Providers who have embraced CDC principles, and innovative practices have enhanced person-centred care, and consumer experience and autonomy. Cultivating inclusive, transparent, and collaborative environments to empower older Australians to shape and control their care provision and wellbeing is a key challenge for providers. [ABSTRACT FROM AUTHOR]

OBJECTIVES Private Equity (PE) involvement in healthcare has been evident in the United States (US) for some time, with questionable benefits reported. There are significant differences in funding, health insurance and regulation in the US, when compared to Australia and New Zealand (NZ), so it is not clear whether existing US research can be generalised to these settings. This study aims to examine published information regarding PE involvement in the private-for-profit (PFP) healthcare sector in Australia and NZ, including evidence of PE shareholdings and its impacts. DESIGN This scoping review considers academic and grey literature, including academic research and commentary papers, media reports, corporate reports, PFP healthcare websites and government submissions. MAIN OUTCOME & RESULTS Thirty-three relevant sources were identified, but no specific information on the impacts of PE investment were discovered. The academic papers highlight an ongoing debate (but limited research evidence) about PFP healthcare, including the quality of clinical care, practice consolidation and a downward trend on clinician ownership. The grey literature offered more information on PE investment and growth of the PFP sector, but limited detail about shareholdings. CONCLUSION With little research on PE investment in Australia and NZ, it is difficult to know if continued PE growth will have a positive or negative affect on operational performance and outcomes, such as clinician engagement and clinical care. The authors conclude that there is a shifting landscape of PFP healthcare in Australia and NZ, to less clinician and greater PE ownership. Given the reports of negative impacts of PE involvement in the US, these trends pose significant immediate and long-term implications. This paper sets the agenda for further research to explore the organisational and system-level impacts of PE growth in Australia and NZ. [ABSTRACT FROM AUTHOR]

Introduction: Occupational therapy in residential aged care facilities (RACFs) can enhance residents' occupational engagement and wellbeing. However, industry reports suggest that occupational therapists in Australian RACFs have mostly provided physical therapies such as pain management via massage and not addressed residents' occupations. There is limited literature on what constitutes occupational therapists' practice in RACFs to inform policy and practice. The aim of this cross‐sectional survey was to explore practice patterns of occupational therapists working in Australian RACFs and influences on their practice. Methods: Occupational therapists working in Australian RACFs were invited from July 2019 to March 2020 to complete a self‐report online questionnaire via email and advertisements on industry websites, newsletters, and social media. The questionnaire asked therapists about their caseload, referrals, assessments, and interventions. Data were analysed descriptively and presented as frequencies and percentages. Results: A total of 214 occupational therapists completed the survey. Occupational therapists' daily practice largely focussed on pain management; other areas of practice included falls prevention, pressure care, and mobility. The Aged Care Funding Instrument in place at the time of the survey was identified as the leading factor influencing therapists' choice of assessments and interventions. Organisational policies and procedures were also perceived as key factors influencing occupational therapy practice. Conclusion: This paper highlights the influence of government funding and organisational policies in limiting occupational therapists' scope of practice and their ability to fully address the occupational needs of residents. Occupational therapists and the profession in general should be aware of factors in aged care funding models, and their application, that restrict occupational therapy practice and inhibit residents' function and advocate for change where needed. With the introduction of the Australian National Aged Care Classification funding model replacing Aged Care Funding Instrument, future research should explore potential changes to therapists practice following the implementation of the new funding model. [ABSTRACT FROM AUTHOR]

Aims Context Approach Conclusion This commentary aims to assist emerging leaders of mental health research with older rural Australians through (i) affirmation that others share the barriers, pitfalls and challenges being faced; (ii) reinforcing the rationale making this a pertinent area for research; and (iii) opening a dialogue for best practice to engage older rural Australians in mental health research.Supporting the mental health of older adults is a pertinent global challenge, none more so than in rural Australia where restricted access to services and supports are compounded by limited help‐seeking behaviours and capacity to engage with support. Paradoxically, such limitations also extend to impact researchers' ability to engage rural older Australians in mental health research, particularly when combined with the stoicism and stigma that often envelopes mental health, and the contemporary challenges posed by the emergence of technology. Such challenges are however not often discussed, more‐often sidelined in favour of reporting positive research outcomes, or seeing emerging researchers eschew such focus entirely.Through this paper, the authors utilised critical self‐appraisal and iterative reflection to identify four recommendations for undertaking contemporary mental health research with rural older Australians, namely to: plan realistically through a collaborative, authentic and respectful approach; identify community champions and build/maintain trust; diversify thought, approaches and methodology; and cast the research net far, wide and often.By adopting recommendations, researchers can maximise accessibility to and possible participation in mental health research, providing foundations for older rural Australians' contributions to inform the development of policies and strategies to promote their health and well‐being. [ABSTRACT FROM AUTHOR]

Background: The impact of Australia's diverse population on the aged care sector has been acknowledged, with the Royal Commission into Aged Care Quality and Safety findings providing evidence of the importance of population diversity for consumer-directed and person-centred care. Similarly, the Aged Care Quality Standards and Aged Care Diversity Framework acknowledge the diversity of Australia's ageing population and potential implications for equitable access to care and the ensuing importance of culturally appropriate and culturally safe care. This paper reports on the development of informational web pages and utilisation findings for use by the aged care workforce supporting diverse populations. Methods: Content was created for the End of Life Directions for Aged Care website, based on rapid review findings relating to barriers and limitations for people accessing equitable care in the aged care and palliative care sectors. Results: Website pages containing embedded links to useful content and resources for health professionals and care workers who work with older diverse adults are shown to be well received among users. Conclusions: As Australia's future population will age with increasing diversity markers, with implications for aged care and palliative care service provision, workforce access to up-to-date, relevant and evidence-informed information on best practice non-clinical support for individuals from diverse backgrounds towards the end of life promotes a person-centred care approach. Access data shows that the website content is being utilised increasingly over time and suggests that it is filling a gap in comprehensive and accessible end of life resources that have been missing from the Australian aged care and palliative care workforce. Consumer-directed and person-centred care is crucial in appropriately servicing all older adults, given each older adult has a diverse background, which impacts their aged care experiences. This paper reports on the development of web pages designed to support the knowledge and information needs of the aged care workforce. There is a need for such resources within this sector to inform culturally appropriate and safe care. [ABSTRACT FROM AUTHOR]

Objective: To compare the historical staffing patterns and organisational characteristics of Australian residential aged care facilities (RACFs) against the new minimum staffing standards recommended by the Royal Commission into Aged Care Quality and Safety (RCACQS). Method: Retrospective data analysis was used to compare the staffing levels and characteristics of 1705 RACFs (for 4 years, 2016–19) with the three new mandatory staffing requirements. De-identified datasets were provided by the RCACQS, obtained under its legal authority. Results: Only 3.8% of RACFs have staffing levels at or above all three requirements. Although many (79.7%) already meet the requirement to have a registered nurse (RN) on-site for morning and afternoon shifts, few have staffing levels above requirements for total direct care per resident per day (10.4%) or care provided by an RN per resident per day (11.1%). Historical levels of on-site RNs, total direct care, and RN care vary significantly across facilities of different size, location and provider scale. Conclusion: The new staffing standards, to be mandatory by 2023, prescribe minimum requirements significantly higher than existing levels, particularly in care per resident per day. Each of the three requirements will likely have a differential effect for different types of RACFs. What is known about the topic?: International evidence suggests that introducing mandatory minimum staffing standards tends to increase the amount of care provided by staff in residential aged care facilities (RACFs). However, the impact of staffing standards is influenced by the stringency of the minimum threshold relative to existing staffing levels, the capacity of organisations to increase their staffing levels, and the specific way the regulation is formulated. What does this paper add?: This paper explores the potential implications of the three national minimum staffing standards, to be in force by October 2023, specifying total direct care, care received by a registered nurse (RN), and an RN on-site. By examining the existing staffing levels of Australian RACFs, it identifies the extent to which facilities already meet the new standards and the characteristics of facilities with staffing levels above and below the three requirements (individually and in combination). What are the implications for practitioners?: The study informs both policy and practice in relation to the likely effects of implementing the national minimum staffing standards for residential aged care in Australia. It demonstrates that the new minimum thresholds are likely to require substantial increases in staffing across the sector, both in terms of all direct care workers and RNs. It also shows that the three requirements are likely to have a differential effect for RACFs of different size, location and chain affiliation, thereby guiding policy about the future needs for Australia's aged care workforce. [ABSTRACT FROM AUTHOR]

Intergenerational care is a program where both the younger and older generations are receiving programmed care in an environment where activities and resources are shared between them. Anecdotally, an intergenerational care program takes on many forms. This paper presents a systematic literature review of intergenerational care models. Our findings are relevant to policy makers as the paper highlights the opportunities to create an age-friendly environment by introducing intergenerational models in Australia, where intergenerational care development is in its infancy. Future research will help articulate the personal, social, and economic value of intergenerational care. [ABSTRACT FROM AUTHOR]

The home care sector comprises one of Australia’s fastest growing workforces, yet few papers capture the overall landscape of Australian home care. This integrative review investigates home care with the aim of better understanding care recipients and their needs, funding, and regulation; care worker skills, tasks, demographics, employment conditions, and training needs. Over 2,700 pieces of literature were analyzed to inform this review. Results suggest sector fragmentation and a home care workforce who, although well-placed to improve outcomes for care recipients, are in need of better training and employment support. Suggestions for future research regarding Australian home care include studies that combine both aged and disability aspects of care, more research around care recipients, priority needs and strategies for addressing them, and how best to prepare home care workers for their roles. [ABSTRACT FROM AUTHOR]

While many of the maladies of the 20th century are steadily coming under control, the march of neurodegenerative disorders continues largely unchecked. Dementias are an exemplar of such disorders; their incidence and prevalence continue to rise, in large part due to a steadily ageing population worldwide. They represent a group of chronic, progressive and, ultimately, fatal neurodegenerative diseases. Dementia has remained therapeutically recalcitrant. It is not a single disease, and because of that, we cannot expect a single panacea. While primary prevention rightly gains prominence, those with established disease currently require a shift in focus from curative intent towards improved quality of life. Enter palliative care. The sheer number and complexity of needs of patients with dementia, from the physical to the psychosocial and spiritual, necessitates the engagement of a wide range of medical disciplines, nursing and allied health professionals. One of those disciplines, as highlighted in the recent Australian Royal Commission into Aged Care Quality and Safety, is palliative care. This paper shall expand upon that role in the overall context of care for those with dementia. [ABSTRACT FROM AUTHOR]

This paper presents findings from the evaluation of an Australian trial of self‐managed home aged care. The self‐management model was codesigned by advocacy organisation COTA Australia, consumers and service providers. The primary aim of the evaluation was to examine whether self‐management improved consumers' perceptions of their choice, control, and wellbeing. The secondary aim was to examine whether provider prior experience with self‐managed packages significantly influenced consumers' perceptions of choice, control and wellbeing, thereby confounded trial effects. A pre‐test post‐test quasi‐experimental design and mixed‐methods design were used to collect data over nine months in 2018–2019. The pre‐trial methods and findings have been published. The post‐trial evaluation replicated the pre‐trial data collection method of an online survey (n = 60) and semi‐structured telephone interviews with consumers (n = 9), family carers (n = 13), and consumers and carers jointly (n = 2), totalling 24 interviews. Semi‐structured telephone interviews were also conducted with CEOs and senior managers from each of the seven providers (n = 14). Three providers had prior experience supporting self‐management. Parametric and non‐parametric tests examined the statistical data. Qualitative data were analysed thematically and framed according to self‐determination principles and ecological systems theory. Both datasets demonstrated that consumers reported greater choice and control at post‐trial than pre‐trial. This finding was not affected by providers' prior experience with self‐management; therefore, it was not a confounding factor. Participants reported improved wellbeing in interviews, however this was not reinforced statistically. Key desirable features of self‐management included greater autonomy and control over spending, recruiting support staff and paying lower administration fees. There was no evidence of increased risks or fraud. The research limitations included a small sample size, convenience sampling with providers recruiting interview participants, no control group and differences in trial implementation. The findings support the expansion of self‐management opportunities and more comprehensive evaluations that use mixed methods. [ABSTRACT FROM AUTHOR]

Objective: To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods: A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results: The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions: Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access. What is known about the topic? People living in residential aged care facilities report very high rates of mental health conditions, including depression and anxiety. What does this paper add? We demonstrate very low use (<3%) of Government-funded mental health services among people living in residential aged care facilities in Australia, with only small increases in use over time. What are the implications for practitioners? Practitioners should routinely assess the mental health needs of people living in residential aged care and refer for in-reach mental health services where needed, noting that facility staff are usually not trained for this role. [ABSTRACT FROM AUTHOR]

Objective: To investigate the perspectives of Australian nursing educators on the preparation of Bachelor of Nursing students for the care of older people's oral health. Background: The Australian population is ageing. Older people with poor oral health are at increased risk of worsening health and chronic disease conditions. Nurses can and need to take a leadership role in improving and maintaining older Australians' oral health in community, hospital, and residential care settings. Thus, it is important to investigate the perspectives of nursing educators on the preparation of nursing students for the care of older people's oral health. Study design and methods: Semi-structured interviews were conducted with 13 participants, including course coordinators, lecturers, directors, and researchers at 10 universities delivering accredited Bachelor of Nursing programs across seven different states in Australia. Data were analysed thematically. Results: Four themes were identified in nursing educators' perspectives: (1) the education of nursing students in providing oral healthcare is important, (2) there are notable gaps in nursing students' oral health education, (3) there are both internal and external barriers to strengthening oral health education across nursing programs, and (4) there is a need to develop and promote a shared oral health curriculum that includes interprofessional education and collaborative practice. Inherent in these themes was the need for a clear definition of the role of nurses in oral healthcare. Discussion and Conclusion: It is recommended that administrators and policymakers develop nursing accreditation standards that specify the role of nurses in oral health education, and the scope of this education including interprofessional and collaborative practice, for the oral healthcare of older people. Infusing such standards in nursing curricula will better educate and prepare nursing students for effective practice and leadership in gerontological care. What is already known about the topic? * Older people frequently have oral diseases that adversely affect chronic health conditions and increase the risk of poorer general health. * Even though oral healthcare is an essential part of nursing for older people, the provision of such care is implied rather than stated specifically in Australian Nursing and Midwifery Accreditation Council (ANMAC) standards. What this paper adds: * The education and preparation of students to provide oral healthcare appears to be expected rather than required in Australian nursing curricula. Based on the perspectives of nursing educators, this paper suggests that many nursing students may not be well prepared to provide evidence-based oral care and lead oral health initiatives. The paper identifies ways these issues can be addressed. * The paper discusses the importance of developing and promoting a clear oral health curriculum that includes interprofessional collaborative practice to strengthen nursing students' education and prepare them to provide effective oral healthcare for older people. * The paper outlines a needed definition of the role of nurses in providing oral healthcare. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had widespread impacts on the community and has demanded a rapid response from the aged care sector. System changes for infection control have been required including the use of personal protective equipment, lockdowns, visitor restrictions and changes to activities within aged care facilities. Even prior to COVID-19, the high physical and emotional demands of aged care work were recognised. Objective: This study sought to understand aged care workers' experiences of the COVID-19 pandemic. Methods: Using a pragmatic paradigm qualitative data about work experiences during COVID-19 was collected from people employed in different aged care organisations in a range of aged care roles and settings from multiple Australian states. Data was collected using focus groups and interviews conducted online between August-October 2020. Inductive thematic analysis was used to identify key themes in the data. results: Participants included 15 people working across a range of aged care roles including clinical, care and management staff and across both residential and community settings. Five themes were identified which characterised aged care workers thoughts about their jobs during the pandemic. These included intensified procedures and emotional demands, feeling undervalued and detached from the frontline, exposure of existing system deficiencies, recognising teamwork and increased confidence in technology. conclusion: Reflecting on aged care workers' experiences of COVID-19 highlights the need to better support workers and acknowledge their important role in caring for older Australians. This includes at an organisational level by providing supportive environments and access to online resources as well as at the community and policy level by recognising aged care workers as frontline workers. The COVID-19 pandemic has also highlighted existing systemic issues in the aged care sector that need to be addressed for the provision of quality aged care in Australia during the COVID-19 pandemic and into the future. What is already known about the topic? * While the COVID-19 pandemic is affecting the global community, it is disproportionately impacting the aged care sector with higher rates of severe illness and death and wide-ranging system changes to prevent and control the spread of the virus. * Prior to COVID-19, aged care work was associated with high job demands and lack of access to resources to support aged care workers in their role. * Survey data on the Australian RACF workforce found workers felt prepared for the pandemic with a wide range of measures to control the spread of COVID-19 but they faced several challenges associated with their additional roles and restrictions. What this paper adds * This paper provides qualitative and descriptive insights into the challenges experienced by the Australian aged care workforce during COVID-19 including increased workloads and intensified emotional demands of their roles while at the same time feeling undervalued by the wider community. * This study has highlighted the need to better support and acknowledge aged care workers in the community through their portrayal in the media and within their organisations by facilitating supportive team environments and providing access to online resources and training. * This paper discusses existing systemic issues that have been highlighted by COVID-19 and the Royal Commission into Aged Care Quality and Safety and need to be addressed for the wellbeing of workers and the provision of quality aged care. [ABSTRACT FROM AUTHOR]

Introduction: Although various studies have examined availability, access barriers and patient experiences of rural health services for the ageing population, no synthesis of this literature exists in Australia. Objective: The objective of this study was to examine the current literature surrounding rural service provision and to evaluate the barriers to access for older individuals and to recognise gaps in the literature. Design: A systematic scoping review of peer‐reviewed literature from three online databases (PUBMED, SCOPUS and Web of Science). Findings: Thirty‐two papers were included in analysis. The most prominent types of health service discussed were residential aged care (n = 12) and community health care (n = 10). More studies explored the perspectives of health personnel than the service end users. Qualitative synthesis revealed three themes associated with health service and rural ageing: access to services, health workforce experiences and end user experiences. Discussion: Access to health services for the elderly population is a complex issue. Promoting positive experiences for both health providers and patients is critical to assisting in healthy ageing for people living in rural and remote areas. This requires intervention on a social and institutional level. Key research gaps in the literature include the effectiveness of an integrated approach to institutional interventions, utilisation of preventative measures such as screening programs for cancer and greater identification of the health needs and perceptions among culturally diverse elderly residents. These studies are critical to promote appropriate and patient‐centred care for elderly populations in rural and remote areas. Conclusion: The review highlights the need to address availability, retention and service innovations across health services to improve access to care and health outcomes of rural elderly residents. [ABSTRACT FROM AUTHOR]

The recent Royal Commission into Aged Care Quality and Safety in Australia has documented systemic failures and shocking incidences of abuse and neglect, a not uncommon story internationally. As aged care in many countries is predominantly publicly funded, it is important to understand the general public's attitudes towards aged care quality, what aspects of care quality they think are most important and their willingness to contribute to increased funding to the sector. This paper asks specifically whether self-reported aged care literacy impacts expectations and willingness to pay. More than 10,000 members of the general population were surveyed stratified by age, gender and state. Regardless of the level of aged care literacy, there was consensus about what constitutes quality care, and care priorities for the sector. However, aged care literacy affected willingness to pay to fund a better-quality aged care system. The current crisis facing Australia's aged care system and that of many other countries internationally demonstrates the central importance of general public support to drive quality improvements, recognising that increasing public expenditure on aged care is a necessary part of the solution. This study provides important baseline data from which to commence national and international conversations to consider all options for ensuring the quality, safety and sustainability of aged care now and into the future. [ABSTRACT FROM AUTHOR]

This article argues the voice of people with dementia was missing from the Australian Royal Commission into Aged Care Quality and Safety (RCAC) Final Report. This absence was notwithstanding that the RCAC was explicitly tasked to inquire into dementia care. The RCAC Final Report is shown to marginalise the perspective and experience of people with dementia in the aged care system at the same time as prioritising substitute voices of experts, advocates, family and care partners. This absence of voice repeats and re-inscribes framing of people with dementia as "missing persons". Where people with dementia face practical and legal barriers to participate in civic and legal processes, the RCAC failed to adjust its methodologies to ensure their voices were "heard". The RCAC's re-inscription of marginalisation of people with dementia raises concerns for the legitimacy and success of its recommendations for dementia aged care reform. [ABSTRACT FROM AUTHOR]

Until the 1970s the Asia-born population of Australia remained small due to the racist White Australia Policy which denied entry to non-Europeans. Following its abolition in the early 1970s, Asian immigration progressively intensified, and in 2016 the Asia-born population of the country reached a total of 2.7 million, though the older population aged 65+ remained relatively small. This paper presents new projections of Australia's older Asia-born populations from 2016 to 2056 created with a new birthplace projection model. The results show substantial growth of the older Asia-born population can be expected over coming decades, along with changing composition by country of birth. The Asia-born proportion of Australia's older population overall is projected to rise from just 6 per cent in 2016 to 19 per cent in 2056. These coming demographic changes present challenges and opportunities - in particular relating to the provision of culturally appropriate residential and community aged care. [ABSTRACT FROM AUTHOR]

Purpose: Between 55–65% of residents living in residential aged care facilities (RACFs) experience dysphagia and are prescribed texture-modified diets by a speech-language pathologist (SLP). The aim of this study was to assess current adherence to prescribed texture modification for people with dysphagia; and explore barriers to implementation in a rural aged care setting. Method: Meal texture audits (N = 42) were completed with residents with dysphagia in a rural RACF who were prescribed texture-modified diets or fluids by a SLP. Semi-structured focus groups were conducted with nursing and food preparation staff (N = 11) to identify barriers to implementation. Result: Mealtime texture audits identified that 54.8% (n = 23) of residents' food modification requirements were incorrectly documented in the manual entry database (kitchen form) and 64.3% (n = 27) of meal trays contained foods that did not meet residents' dysphagia management plans. Focus group data revealed seven main themes impacting on the ability of staff to implement prescribed texture-modified diets. Complicated processes and communication between nursing, food services and SLP staff were identified as major barriers. These were complicated further by time pressures experienced by staff as well as staffing issues, resourcing of the kitchen, accommodating individual dietary preferences and the variety/presentation of dietary options at the aged care facility. Conclusion: There was low adherence to SLP prescribed texture-modified diets and fluids in the participating rural RACF. This study identified major barriers to implementing SLP prescribed texture-modified diets including complicated processes, communication breakdowns, time pressures and limited staffing. Implementation of an online menu management system and regular dysphagia-specific training may address barriers to communication and complicated paper-based menu systems and should be a priority for health services to ensure adequate dysphagia management. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this paper is to investigate the utilisation of general practice Medicare Benefit Schedule (MBS) services aligned to Comprehensive Geriatric Assessment (CGA) within 6 months of an aged care eligibility assessment and its effects on mortality and transition to permanent residential aged care (PRAC). Design Retrospective cohort study from the Historical Cohort of the Registry of Senior Australians. Setting Community. Participants In total, 69,171 Individuals (aged 75+) receiving home care packages (HCPs) between 2011 and 2015. Outcome measures Mortality and transition to PRAC. Results The claims for a management plan with team care arrangement (TCA) within 3 months of the health assessment (i.e. CGA) was present in 5% and associated with 14% lower mortality (adjusted hazard ratio [aHR], 95%CI = 0.86, 0.80–0.93) compared to no claims, lower than that seen with partial CGA which was either health assessment claims only 7.0% (aHR, 95%CI = 0.93, 0.89–0.97) or management plan coupled with TCA claims only 9.0% (aHR, 95%CI = 0.91, 0.89–0.97). This pattern was seen in those frailer but not in those where the frailty index score was <0.21. Claims for management plans coupled with TCAs alone were associated with a 10% lower transition to PRAC (asHR, 95%CI = 0.90, 0.85–0.96) in those with FI score < 0.21 while this estimate was not significant in individuals with FI score ≥ 0.21. Conclusion It appears the conduct of a combination of interventions considered to be components of the CGA by GPs was associated with a lower risk of mortality that no claims or partial conduct of CGA. [ABSTRACT FROM AUTHOR]

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Aim: The aim of this paper is to explore the process of staff leading change in consumer engagement practice in aged care. Background: Shifting expectations make engagement practice increasingly complex for service providers. This requires adaptive change within organisations. Organisations need to empower and support staff to critically assess practice, identify issues and pursue opportunities for innovation. Method: Data were collected as part of an action research project addressing client engagement practice in Australian aged care. Staff worked together to identify issues for practice, generate solutions and create change within their organisations. Results: Staff identified innovative ways of generating change, demonstrating leadership. However, a range of technical, practical, systemic and philosophical factors impacted their progress. Conclusions: Staff are effective, proactive change agents who can provide valuable insights into directions for their organisations and can lead practice improvement in engagement. However, they require support through the organisational environment. Implications for Nursing Management: Staff in all roles can demonstrate adaptive leadership in changing engagement practice. However, those in traditional roles of authority need to recognize their own roles in showing leadership and supporting adaptive change. This provides a new insight into how managers can support practice change in consumer engagement. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to develop a validated model to predict current and future Australian costs for people with dementia to help guide decision makers allocate scarce resources in the presence of capacity constraints. Methods: A hybrid discrete event simulation was developed to predict costs borne in Australia for people with dementia from 2015 to 2050. The costs captured included community-based care, permanent and respite residential aged care, hospitalisation, transitional care, pharmaceuticals, aged care assessments, out of hospital medical services and other programs. Results: The costs borne for people with dementia in Australia are predicted to increase from A$11.8 billion in 2015 to A$33.6 billion in 2050 at 2013–14 prices, ceteris paribus. If real per capita health and social expenditure increased by 1.0% annually, these costs are predicted to increase by around A$14.2 billion to a total of around A$47.8 billion by 2050. Conclusions: This simulation provides useful estimates of the potential future costs that will be borne for people with dementia and allows the exploration of the effects of capacity constraints on these costs. The model demonstrates that the level of real annual per capita growth in health and social expenditure has significant implications for the future sustainability of dementia care in Australia. What is known about the topic?: With the aging of the Australian population, the number of people living with dementia is predicted to rise markedly in the next four decades. As the number of people living with dementia increases, so too will the financial burden these debilitating and degenerative diseases place on private and public resources. These increases are likely to challenge the efficiency and sustainability of many health systems in the developed world. What does this paper add?: This research provides a validated model to predict current and future Australian costs for people with dementia to help guide decision makers allocate scarce resources in the presence of capacity constraints (i.e. where the supply of resources does not meet demand). The model predicts an increase in costs for people with dementia from A$11.8 billion in 2015 to A$33.6 billion in 2050 at 2013–14 prices. If real per capita health and social expenditure increased by 1.0% annually, these costs are predicted to increase by around A$14.2 billion to a total of around A$47.8 billion by 2050. What are the implications for practitioners?: This simulation provides useful estimates of the potential future costs that will be borne for people with dementia and allows the exploration of the effects of capacity constraints on these costs. The model demonstrates that the level of real annual per capita growth in health and social expenditure has significant implications for the future sustainability of dementia care in Australia. [ABSTRACT FROM AUTHOR]

In the Australian context, the out-of-home care of children and respite service for older adults are segregated. Yet internationally there has been a shift toward intergenerational programs that purposefully bring together younger and older people for mutual benefits. This paper examines the enablers of, supports for, and constraints of introducing intergenerational care programs (IGC) within the Australian legislation and regulations of child-care and aged-care programs. In doing so, program design features, workforce strategies, and built environment are considered. The literature indicates that the meshing of standards into IGC programs provides an opportunity to make intergenerational care an attractive model for respite to caregivers and recipients of care, while providing intergenerational contact for younger families. Such a program is likely to be cost effective with economies-of-scale workforce efficiencies. Future research will involve a needs assessment of potential consumers to explore the possible demand for intergenerational care programs within Australia before conducting a trial of different intergenerational care programs. [ABSTRACT FROM PUBLISHER]

Australia's Royal Commission into Aged Care Quality and Safety has concluded. The Commission's final report described a sector failing to deliver care that older Australians deserve despite the best efforts of many staff. Throughout the Commission, staffing was a frequent concern, with the size and composition of the direct care workforce a prominent focus. Throughout the Commission, many stakeholders campaigned for mandated staffing levels in skills mix in nursing homes and the Commission's report and Commonwealth Government response included recommendations for these. While this is a necessary step toward wider reform, the Royal Commission's recommendation and the Australian Government's response must support the delivery of best practice care more strongly. This column argues that the minimum standard for nursing home staff care time must be higher, and that higher minimum staffing levels and more clearly defined skills mix are critical to the delivery of safe, respectful, dignified person-centred care. [ABSTRACT FROM AUTHOR]

As the first woman to win the Nobel Prize in economics, Elinor Ostrom has attracted the interest of many feminist economists. Best known for her work on common pool resources, Ostrom made numerous theoretical and methodological contributions to economics, many of which are useful for feminist economists. This paper explores Ostrom's work on coproduction: the active participation of individuals who receive a good or service in the production process. A particular focus is on how Ostrom's model of coproduction might be applied and extended to capture the characteristics and circumstances of aged care. Data from interviews with women employed in Australia's aged-care sector are used to inform a discussion of coproduction in aged care and the institutional supports necessary for successful outcomes. Key issues include the skills and resourcing of aged-care workers, and their authority to negotiate care practice with care recipients under current governance arrangements. [ABSTRACT FROM AUTHOR]

Purpose Integrated care is gaining popularity in Australian public policy as an acceptable means to address the needs of the unwell aged. The purpose of this paper is to investigate contemporary models of integrated care for community dwelling older persons in Australia and discuss how public policy has been interpreted at the service delivery level to improve the quality of care for the older person.Design/methodology/approach A scoping review was conducted for peer-reviewed and grey literature on integrated care for the older person in Australia. Publications from 2007 to present that described community-based enablement models were included.Findings Care co-ordination is popular in assisting the older person to bridge the gap between existing, disparate health and social care services. The role of primary care is respected but communication with the general practitioner and introduction of new roles into an existing system is challenging. Older persons value the role of the care co-ordinator and while robust model evaluation is rare, there is evidence of integrated care reducing emergency department presentations and stabilising quality of life of participants. Technology is an underutilised facilitator of integration in Australia. Innovative funding solutions and a long-term commitment to health system redesign is required for integrated care to extend beyond care co-ordination.Originality/value This scoping review summarises the contemporary evidence base for integrated care for the community dwelling older person in Australia and proposes the barriers and enablers for consideration of implementation of any such model within this health system. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to contribute a critical perspective to debate on health disparities in Australia by examining the ways in which information technology (IT) can support more inclusive communication on aged care with refugee and migrant communities from culturally and linguistically diverse (CALD) backgrounds. Design/methodology/approach – The paper analyses research and policy literature on Australian aged care, IT and participatory approaches to health communication influenced by Friere's critical pedagogy. It distils significant themes for comparison with findings from: a qualitative research project involving communities from Vietnamese, Sudanese and Samoan backgrounds and elderly members of those groups; and, a later case study conducted with elderly women of Vietnamese background. Both projects were based in Melbourne's west. Findings – Friere's theoretical framework can be used to more fully determine the capacity of IT to perform inclusive communication on aged care with refugee and migrant communities from CALD backgrounds. This is best actioned through future research and practice that: prioritizes specific aged care issues; focuses on expanding the “transformation” and “critical consciousness” elements of Friere's dialogical theory; and, uses affordable, accessible and “multi-modal” IT combined with face-to-face bilingual facilitation and two-way communication between participants and health, community and university professionals. Research limitations/implications – Due to the conceptual nature of the paper, the research results lack generalizability. Therefore, researchers are encouraged to test the reccomendations further. Originality/value – The paper fills a gap in understanding about what may help in developing more inclusive aged care information using IT with elderly refugees and migrants from CALD backgrounds in Australia. [ABSTRACT FROM AUTHOR]

A community aged care service, with the assistance of other stakeholders, initiated a qualitative practice-oriented research project to interview baby boomers about their plans for retirement and their interests in volunteering. The project looks to reshape baby boomer volunteering for our aged care services. Our findings highlight that baby boomers are looking for meaningful, diverse and flexible volunteer opportunities. This will require organisations to adapt their volunteer programs and develop the required infrastructure (improved advertising, assessment and volunteer support approaches) to cater for the volunteering needs of baby boomers. This paper highlights the process, findings, initial efforts and future challenges to engaging baby boomers in volunteer work. It is recognised that further research is required in what is not a homogenous group. [ABSTRACT FROM AUTHOR]

Client engagement is an important part of contemporary aged care. However, the extent to which decisions are delegated to the older person, and the scope of issues about which decision making occurs, vary. The types of engagement that are offered to, and taken up by, aged-care clients have implications for the extent of power and influence older people hold. This paper reports on a qualitative study conducted in a large Australian service provider. It identifies the forms that client engagement takes in the aged-care context, the roles for staff and older people that are enacted through these activities, and the implications these have for power relationships and older people's influence. An inverse relationship was seen between the depth and scope of client influence, but a desire to address this suggested potential spaces for greater empowerment. A relationship was evident between the retention of control by staff and the perceived effectiveness of existing engagement strategies, highlighting the limitations of traditional power dynamics in engagement practice. An expanded model of engagement in aged care is proposed that recognises the foundational role of connection building as a facilitator of greater empowerment for older people. Implications for theory regarding engagement in aged care, and the practice of engagement in aged-care organisations, are discussed. [ABSTRACT FROM AUTHOR]

The acute health care system in Australia, as in the global north, has been increasingly dominated by neoliberal market principles prioritising efficiency and cost reduction. This has occurred in conjunction with a shift towards ‘personalised care’ models in health and social services. Personalised care models are intended to support the provision of holistic health care and consumer choice. Yet, the bureaucratic context of acute health care produces constrained applications of person-centred care that can undermine patient participation. Personalised care models have been criticised for diminishing the choices available to socioeconomically disadvantaged groups. There has been scant attention to these equity issues and ethical implications of the model for older people transferring from acute hospital settings to residential aged care. This is significant, as this major life event is associated with social- and identity-related losses; can produce poor health outcomes; and is affecting an increasing population of older people. The aim of this paper is to address this gap in the debate through a critical literature review applying Tronto’s critical ethics of care. We highlight the current Australian context for this patient group and the transferability of palliative care models as an example for change in practice and resource allocation. [ABSTRACT FROM PUBLISHER]

Background: Research has highlighted a need to improve the quality of clinical documentation and data within aged care and disability services in Australia to support improved regulatory reporting and ensure quality and safety of services. However, the specific causes of data quality issues within aged care and disability services and solutions for optimisation are not well understood. Objectives: This study explored aged care and disability workforce (referred to as 'data-users') experiences and perceived root causes of clinical data quality issues at a large aged care and disability services provider in Western Australia, to inform optimisation solutions. Methods: A purposive sample of n = 135 aged care and disability staff (including community-based and residential-based) in clinical, care, administrative and/or management roles participated in semi-structured interviews and web-based surveys. Data were analysed using an inductive thematic analysis method, where themes and subthemes were derived. Results: Eight overarching causes of data and documentation quality issues were identified: (1) staff-related challenges, (2) education and training, (3) external barriers, (4) operational guidelines and procedures, (5) organisational practices and culture, (6) technological infrastructure, (7) systems design limitations, and (8) systems configuration-related challenges. Conclusion: The quality of clinical data and documentation within aged care and disability services is influenced by a complex interplay of internal and external factors. Coordinated and collaborative effort is required between service providers and the wider sector to identify behavioural and technical optimisation solutions to support safe and high-quality care and improved regulatory reporting. [ABSTRACT FROM AUTHOR]

This paper explores issues concerning the development of linkages across the interface between acute and community aged care services in a small regional Australian city. It addresses a participatory action research project that took place over a 2 year period involving an Aged Care Assessment Team (ACAT). Aged Care Assessment Teams are multidisciplinary teams whose members mediate between hospitals and the aged care system in the community and have a key role in developing networks and linkages between various service providers in the field. In an age of economic rationalist-inspired reform agendas in health and community care, rural infrastructures have been compromised to such a degree that the role of rural ACAT in developing linkages between sectors has never been more important. This paper takes up this issue and addresses the project findings, which highlight a field characterised by ineffective linkages within and between the various sectors, a lack of understanding of the operation of the rural aged care system among nurses working in regional hospitals, and the efficacy of ACAT working collaboratively with nurses to create new and more effective linkages in aged care. [ABSTRACT FROM AUTHOR]

Objective. Health-related apps on mobile devices (mHealth apps) have become an effective selfmanagement tool and treatment support for patients. There is limited research, however, on how older people (50 and over) perceive the opportunity of using mHealth apps. Our aim was to investigate the perceptions of older people in Australia regarding the opportunity of using prescribed or doctor-recommended mHealth apps and provide insights which can enhance their uptake of mHealth. Methods. This was a qualitative study using semi-structured interviews involving 21 participants aged 51-82 years. Qualitative thematic analysis was used to categorise the factors that influence the adoption of mHealth apps by older adults. Results. We show that beyond the prominent influencing factors from technology adoption research (such as performance and effort expectancy, social influence and facilitating conditions), health-specific factors such as a trusting doctor-patient relationship and strong health self-efficacy positively influence the intended adoption of mHealth apps among older adults. In addition, the IT security and accurate interpretation of participants' input in an mHealth app can present barriers to mHealth app adoption. Conclusion. Our analyses provide additional insights complementing existing technology adoption research. Their successful adoption and utilisation require further empirical evidence on its effectiveness along with attention to the voices of those who are meant to use them. To address potential barriers, improve the quality and security of mHealth apps, and thus achieve greater patient safety, the involvement of consumers, regulators and health professionals is necessary. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to calculate the baseline carbon inventory of Mercy Health, a provider of health and aged care services in Australia, across emission Scopes 1, 2 and 3. The carbon inventory has clarified the baseline environmental impact, identified carbon hotspots and will inform emissions reduction interventions and a decarbonisation trajectory. Methods. A hybrid carbon footprinting methodology was devised. Established carbon footprinting standards provided methodological guidance. A consulting firm with health service carbon accounting experience provided expertise, rigour and objectivity to the work. Results. In the 2020–21 financial year, the carbon footprint of Mercy Health was 102.96k tCO2-e. Scope 1 emissions accounted for 11.07% (11.40k tCO2-e), followed by Scope 2 with 29.80% (30.68k tCO2-e) and Scope 3 with 59.13% (60.88k tCO2-e). The largest carbon impost group was Building energy (42.01%; 43.25k tCO2-e), followed by Food and catering (9.42%; 9.70k tCO2-e) and Business services (7.74%; 7.97k tCO2-e). Mercy Health’s Health Services, Aged Care and Support Services divisions contributed 49.16, 47.81 and 3.03% (50.61k, 49.23k and 3.12k tCO2-e) of total greenhouse gas emissions respectively. Conclusions. Mercy Health’s Health Services division and Aged Care division each comprised around half of total organisation carbon emissions. Building energy dominated emissions, particularly electricity. The study discovered meaningful differences in the composition of carbon emissions in operational divisions of the organisation, indicating tailored interventions will be required to meet carbon abatement targets. The study demonstrates the benefit of conducting carbon footprinting within individual organisations, and the importance of studies within the Australian context. [ABSTRACT FROM AUTHOR]

• Papua New Guineans in Australia enact a transnational domestic moral economy. • Social investment in this moral economy is a strategy for insuring care in later life. • Changing intergenerational relations within the domestic moral economy redefine forms of belonging. Drawing on qualitative research conducted among Papua New Guineans living in North Queensland, Australia, this paper explores how people imagine and plan for later life in transnational contexts. We present 'planning' for old age as a socially embedded practice with specific spatial and temporal properties that emerge in everyday interaction. At issue are representations of difference in the cultures of care found in Papua New Guinea (PNG) and Australia and the problem of intergenerational changes in care practices among Papua New Guineans resident in Australia. We argue that growing tensions in intergenerational relationships in Australia and PNG play a crucial role in changing the social relations of the transnational moral economy of care. These intergenerational problems are understood by PNG research participants, in their own critical analysis of their care relationships, as related to other concerns about estrangement from place, loss of culture and the difficulties of planning for later life. We conclude that transnational households are dynamically defined and transformed in terms of tensions central to their very operation. [ABSTRACT FROM AUTHOR]

Background: The aged care system in Australia is under pressure. Residential aged care facilities (RACFs) and general practitioners (GPs) have difficulty providing the care needed by their residents, particularly after hours. Many residents are given ambulance support and transferred to hospital emergency departments (EDs) for care that could be provided at RACFs. The MyEmergencyDoctor (MED) service was commissioned in a 12-month program (February 2020-February 2021) using ED physicians to provide afterhours telehealth care in six RACFs. Methods: Using the NASSS framework, we synthesised descriptive analyses of statistical data from the MED service, RACFs and the ambulance service and a thematic analysis of interview data collected from GPs, RACF and MED service staff, and family members of residents. Results: Most calls to MED (179/209) were resolved with in-house treatment thereby reducing ambulance usage and hospital admissions. Interviews further revealed that MED enabled timely care for residents who were unwell but did not need hospital transfer. Technology, training, and rapid access to MED assisted RACF staff and complemented usual GP care. MED potentially reduced GP burnout. Refresher training was considered important especially in RACFs with high staff turnover, as was greater afterhours access to medications. Conclusions: The afterhours telehealth model provided in-house care and reduced ambulance transfers, and GPs and RACF staff generally felt supported. The service was easy to use and fostered good communications with GPs and RACF staff. Some GPs preferred to provide their own care, commenting on the need for a good understanding of patient and family needs and of the local context. Other stakeholders suggested this model could be extended to palliative care settings and to normal business hours when GPs were unavailable. The reduced ambulance and hospital use suggested benefits to wider health systems, however policies and funding that remunerate GPs, support community-based care and provide additional staffing in RACFs are needed to sustain afterhours telehealth in RACFs. Use of the NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) Framework provided a valuable explanatory lens for our analyses. [ABSTRACT FROM AUTHOR]

Background and aims: The Aspire to Inspire practice development programme took place in the services within one region of an aged care provider in Australia. One year after it ended, the programme team looked back to see how practice development is faring in the region. Method: In this paper, we present a two part reflection one year on. We have drawn on individual reflections written by the programme team facilitators, and on the Person-Centred Care Framework. Conclusion: We found that strong values and beliefs were still present, especially among the programme facilitators and others who had been active in the practice development programme. We also found that a systematic approach and the use of facilitation in everyday work were still valued and that project team members were using a wide range of practice development methods, tools and processes in their new roles. We also found, unsurprisingly, that a wide scale organisational redesign weighed heavily on people, influencing their thinking and feeling about work and their commitment to the job. In summary - and this is tentative - more programmes and projects need to revisit how successful practice development has been in sustaining itself and its impact after formal programmes are completed. Implications for practice: There are implications for practice developers in terms of designing evaluation research and strategies. We found that although practice developers do seem to be more resilient than others during organisational redesign, major changes of this nature have a negative impact on the sustainability of practice development. [ABSTRACT FROM AUTHOR]

Aim To identify key issues and factors affecting retention of qualified nurses who care for older people and persons with dementia in Australian acute, subacute, community and residential health-care settings. Background As the number of older people with chronic conditions needing health care continues to increase research is needed to optimize nurse retention. Methods Qualified nurses were surveyed with a set of items derived from four published nurse workforce questionnaires (Cronbach's alpha range 0.75-0.96). There were 3983 complete responses and 10 focus groups with 58 volunteer survey respondents. Results In addition to reporting a number of workplace issues, nurses also reported reasonable levels of satisfaction. Intrinsic factors related to caregiving, work relations and colleague support. Extrinsic factors included professional opportunities and organisational support. Conclusions Altruism is a primary motivation for choosing to nurse older people and persons with dementia. Nurses are most positive when they feel valued and supported by their organisation and colleagues, through education, training, supervision, mentoring opportunities and appropriate remuneration. Implications for nursing management Nursing managers need to take positive steps to address the organisational factors outlined in this paper that either inhibit or promote nurse retention. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to identify the domains of performance needed by leaders in aged and community care not-for-profit organisations. Design/methodology/approach – Focus groups and individual interviews were conducted with senior managers employed by faith-based aged and community care not-for-profit organisations, academics in ageing and business fields and senior government employees from aged services departments and agencies in Australia. Results were content transcribed and analysed thematically in order to identify the major themes that emerged. Findings – A total of 37 people participated in the study. The domains of performance identified by participants as required of leaders in aged and community care were: professionalism; collaboration and teamwork; judgement and decision making; communication; scholarship and teaching; management; advocacy; and leadership. The performance requirements that were identified for leaders in aged and community care not-for-profit organisations were broader than just leadership per se. Research limitations/implications – The findings of this study suggest that the aged and community care not-for-profit sector has specific requirements for the performance of its leaders. Leadership is one of a number of performance attributes desirable in leaders in this sector. Practical implications – The aged and community care not-for-profit sector has distinctive needs and specific requirements of its leaders. Originality/value – It is recommended that a broad range of performance attributes are taken into account by aged and community care not-for-profit organisations when recruiting and training staff in leadership positions. [ABSTRACT FROM AUTHOR]

The final report of the Productivity Commission Inquiry into Aged Care has recommended a substantial restructuring of Australia's aged care system to make it fairer, more responsive to the needs of individual consumers, and more sustainable in the context of population ageing. While acknowledging the necessity of a safety net and the needs of diverse groups, the recommended reforms continue to advance the neoliberal restructuring of Australia's health and welfare systems. This paper provides a critical examination of the context and key drivers for change, and considers the reception of the report within the aged care sector. While social workers are actively engaged in the aged care system, they are largely absent from the discussion in the final report. Nonetheless, the transfer of recommendations into actual policy provides an opportunity for social work to argue its unique contribution and potential in the delivery of aged care. [ABSTRACT FROM PUBLISHER]

Scand J Caring Sci; 2011; 25; 745-753 Support as a complement, intrusion and right - evidence from ageing and disability support service users in Sweden and Australia How service users conceptualise their personal support services is under researched, even though this understanding is important for responsive policy development and service implementation. This paper tests the proposition that service users understand formal support in three ways: support is a complement to their other arrangements, an intrusion into their personal life and a right. These three concepts were identified using discourse analysis in a Swedish study of older people wanting in-home support services. To test generalisability of these concepts, they were applied to data from an Australian study of people using disability personal support. The analysis found that the three concepts were core to people's views of their support, although the construction of the concepts differed in the two countries. Service users in Sweden asserted their right to services more forcefully than those in Australia, and they had higher expectations that their support needs would be met. These differences reflect the impact of each country's social policy environment on service users' expectations. The analysis suggests that service users and their families want to control their formal support arrangements to complement their informal care and their life preferences and to minimise the intrusive aspects of formal support. The findings imply that the three concepts have utility for theorising service users' perspectives, informing policy and developing implementation strategies which enhance peoples' quality of life. [ABSTRACT FROM AUTHOR]

Since the mid-1980s, Australian governments have focused on expanding community and home-based services for older people. This has led to increased levels of dependency, vulnerability, and complexity to be managed in the community. Consequently, aged care services have had to develop mechanisms for regulating and managing these increased risks, and risk management has become more central to the practices of professional workers in this field. This paper reports on some findings from a large-scale study that explores the way risk management policies have been translated into practice by community-based services in Victoria, Australia. Drawing on interviews with 18 frontline and management professionals employed in community aged care, we found that these workers were wrestling with a diverse and new range of institutional risks beyond those encountered in the actual delivery of frontline care. We found that these workers experienced 'risk' in four different contexts, which often created demands for contradictory or conflicting responses. Here we examine these 'contexts of risk practice': professional workers' relationships with their clients, relationships with other service providers, the unregulated nature of the home as a work environment, and community expectations about the management of risk. Despite tensions that frequently arose, workers expressed strong professional commitments to their clients and were motivated to find positive resolutions amid competing interests. We conclude that tensions experienced by workers were embedded in the structural dimensions of institutional relationships and the systematic absence of shared understandings of 'acceptable' risks in the community care of older people, rather than in the failure of professional agency. [ABSTRACT FROM AUTHOR]