The experience of animal therapy in residential aged care in New Zealand : a narrative analysis : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University, Wellington, New Zealand

Volunteer-led animal visitation programmes are common within Aged Residential Care facilities in New Zealand. Visits by animals and handlers, often referred to as Animal Therapy, are primarily social and intended to improve the quality of life of people in residential care. Animal Therapy has been shown to have both physiological and psychological benefits for older people, including improvements in outlook and social interaction. Very little research has been conducted in New Zealand, particularly on the informal animal visitation programmes typical in care facilities in New Zealand. This project examined the experience of animal therapy in aged residential care. In-depth interviews were conducted with seven older people about their experiences of animal therapy, and analysed using narrative analysis. Older people in residential care do value animal therapy, but it is narrated as a fleeting pleasure, rather than having a long-lasting or far-reaching impact on the daily experience of residential care. In some ways, the structure of the AAA programme may underscore the challenges to everyday autonomy and identity in the everyday lived experience of residential aged care. This can be used to develop services that acknowledge the context of living in aged care for residents

The effect of complex falls prevention interventions on falls in residential aged care settings: A systematic review protocol

The objective of this review is to synthesize the best available evidence on the effectiveness of complex falls prevention interventions on fall reductions in the residential aged care population, implemented at two or more of the following levels: organization, facility or resident. Specifically the review question is: What is the effect of complex falls prevention interventions on falls in residential aged care settings

Safety of opioid patch initiation in Australian residential aged care

Explores opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Abstract Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross-sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period Main outcome measure: The proportion of residents who were opioid-naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid-naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up-titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid-naive in the 4 weeks before initiation. &nbsp

What are we waiting for? [guest editorial]

The clinical education of Australia's aged care nurses can no longer be treated as the Cinderella of nursing's specialities. It is urgent that ways be agreed and measures taken to bring this branch of the profession, and residential aged care nursing in particular, into mainstream health care services. There should be no need to describe again the evolving shape of Australia's demographic profile between now and the middle of this century; and no need to prove here that the ageing bulge is already placing a severe strain on staffmg in the sector. A substantial percentage of the aged care nursing workforce is nearing retirement and the ratio of departures to recruits seems set to worsen at the same time as demand for high quality nursing care escalates. Important indicators - the number of the most highly dependent residents has doubled in the past seven years; compounding co-morbidities are increasingly common and an estimated 60-80% of residents in residential aged care facilities (RACFs) have a dementing illness - reveal the rapidly rising levels of frailty and dependency in the RACF population....

Optimising nutrition in residential aged care: A narrative review

In developed countries the prevalence of protein-energy malnutrition increases with age and multi-morbidities increase nutritional risk in aged care residents in particular. This paper presents a narrative review of the current literature on the identification, prevalence, associated risk factors, consequences, and management of malnutrition in the <i>residential aged care (RAC)</i> setting. We performed searches of English-language publications on <i>Medline, PubMed, Ovid and the Cochrane Library</i> from January 1 1990 to November 25 2015. We found that, on average, half of all residents in aged care are malnourished as a result of factors affecting appetite, dietary intake and nutrient absorption. Malnutrition is associated with a multitude of adverse outcomes, including increased risk of infections, falls, pressure ulcers and hospital admissions, all of which can lead to increased health care costs and poorer quality of life. A number of food and nutrition strategies have demonstrated positive nutritional and clinical outcomes in the <i>RAC</i> setting. These strategies extend beyond simply enhancing the nutritional value of foods and hence necessitate the involvement of a range of committed stakeholders. Implementing a nutritional protocol in <i>RAC</i> facilities that comprises routine nutrition screening, assessment, appropriate nutrition intervention, including attention to food service systems, and monitoring by a multidisciplinary team can help prevent decline in residents’ nutritional status. Food and nutritional issues should be identified early and managed on admission and regularly in the <i>RAC</i> setting

Quality of residential aged care: the consumer perspective

This paper discusses concerns about the quality of care in a minority of residential aged care facilities, and puts forward strategies to address them. Executive summary: Over 222,000 people received permanent residential aged care services in 2012 with over 2,700 residential aged care facilities in operation nationally. The ageing of Australia’s population will result in a significant rise in these numbers in the coming years. Older people in residential aged care are among the most vulnerable in our society, which places them at considerable risk of serious abuse. This risk is due to a host of factors including cognitive impairment and dementia, depression, immobility, limited support and contact with the outside world and difficulties in accessing the appropriate channels through which to raise complaints as well as fear of victimisation for doing so. We acknowledge that the majority of providers are providing good quality care even if they may be constrained by current levels of funding. But there must be zero tolerance for violations of human rights. Over the past several years, consumers have shared their experiences with us of poor quality care and the frustrations they have experienced in attempting to navigate a highly complex system that at times affords little transparency. These stories have included the mismanagement of the behavioural and psychological symptoms of dementia (BPSD), chemical and physical restraint, care recipients treated with a lack of dignity and respect, and psychological, physical and sexual abuse. The stories shared by consumers paint a disturbing picture of an aged care system under strain which is in some cases failing to meet the basic human rights of our most vulnerable citizens. Through the Aged Care Complaints Scheme (the Scheme) and the Aged Care Standards and Accreditation Agency (ACSAA), there are significant protections in place to assist in ensuring a minimum quality of care is provided to residents in aged care services. This report looks at the action that might be taken in the short term to ensure there is zero tolerance of poor care and in the longer term to develop a more consumer oriented care system. The rights of residents and respect for their dignity is not going to be achieved unless there is a coming together of consumers, providers and staff on the action needed. The aged care reforms represent a shift towards increased consumer empowerment, with the implementation of consumer directed care, expansion of home care services, and greater access to information through the development of quality indicators. It is timely to consider how we can provide consumers with a greater role in monitoring quality and standards within the aged care system. The strategies put forward in this paper, whether short or long term, are for discussion. Many of the strategies proposed have been the subject of consideration before but the opportunity to make significant changes to the system has not presented itself as it does now with the current aged care reforms. There is now some urgency for action in the view of Alzheimer’s Australia and our consumer stakeholders

Adequacy of existing residential care arrangements available for young people with severe physical, mental or intellectual disabilities in Australia

Acknowledging that the NDIS alone will not be able to solve the issues faced by young people in nursing homes, this review makes 12 recommendations including establishing a joint taskforce to ensure the recommendations are put in place. LIST OF RECOMMENDATIONS Recommendations to the Australian Government Recommendation 1 6.7 The committee recommends that the Australian Government compile a database of all young people under the age of 65 years living in residential aged care facilities using the data held by the Aged Care Assessment Team (ACAT) program. This list should be provided in a regularly updated form to the National Disability Insurance Agency (NDIA) and to state and territory governments. This data should include the following information: name; age and age of entry to aged care; diagnosis; length of time spent in the aged care system; and the factors that need to be addressed for the person to move out of the aged care facility. Recommendation 2 6.8 The committee recommends that the Australian Bureau of Statistics (ABS) conduct a Longitudinal Survey of Disability, Ageing and Carers in addition to its triennial survey of Disability, Ageing and Carers. Recommendation 3 6.10 The committee recommends that the Australian Government develop and implement a comprehensive assessment and placement tool or residential assessment instrument to assess the care and accommodation needs for all young people living in or at risk of entering residential care. Recommendation 4 6.12 The committee recommends that supplementary assessment guidelines and tools are developed for the ACAT program to ensure that all young people being considered for an aged care placement are properly assessed. As part of this process, the committee recommends that: all young people placed in aged care are intensively case managed; and all ACAT placements for those aged under 65 are reviewed on an annual basis. Recommendation 5 6.13 The committee recommends that the accreditation standards for residential aged care are amended to include standards relating to the clinical outcomes and lifestyle needs of young people. In order to assist with meeting these new accreditation standards, the committee recommends that the Australian Government: • provide a supplementary payment to residential aged care facilities to ensure that these accreditation standards can be met; and • invest in disability specific training for all staff involved in the care of young people living in aged care. This training should focus on building improved awareness of the needs of young people and those living with disability in order to provide better support. It should also lead to improved connectivity between the aged care sector and other service sectors including allied health and disability services. Recommendation 6 6.17 The committee recommends that the Department of Social Services\u27 current discussion paper on disability housing consider capital funding options for construction of specialised disability accommodation. 6.18 The committee recommends that the discussion paper is released as a matter of urgency. 6.19 The committee recommends that the Australian Government establish a supported disability accommodation fund similar to the Supported Accommodation Innovation Fund. Recommendations to the Joint Standing Committee on the National Disability Insurance Scheme Recommendation 7 6.21 The committee recommends that the Joint Standing Committee on the National Disability Insurance Scheme (NDIS) conduct an inquiry into the issue of disability housing after the release of the discussion paper on disability housing. Recommendations to the Council of Australian Governments (COAG) Recommendation 8 6.23 The committee recommends that the COAG develop and implement a national rehabilitation strategy including a framework for the delivery of slow stream rehabilitation in all jurisdictions. Recommendation 9 6.28 The committee recommends that the NDIS, in all NDIS trial sites, and the relevant state or territory government in all other areas: • assign an advocate to all young people living in residential care to provide information to a young person and their families about their options. If appropriate, the advocate can act on behalf of the young person; • assign an advocate to all young people at risk of entering residential care to provide information to a young person and their families about their options. If appropriate, the advocate can act on behalf of the young person. The advocate should be made available as early as possible after diagnosis of an illness or disability and be assigned before any placement commences; • extend the National Younger Onset Dementia Key Worker Program (YODKWP) to all young people identified as being at risk of placement in residential care to provide collaborative case management. The key worker should be assigned before any placement commences; and • these programs should be proactively extended to young people living in residential care facilities under the age of 65 years by June 2017. Consideration of the mental health status of young people should be prioritised with appropriate support provided where necessary. Recommendation 10 6.30 The committee recommends that the NDIS, in all NDIS trial sites, should consider how it supports those with Foetal Alcohol Spectrum Disorder (FASD). 6.31 The committee also recommends that the NDIS, in all NDIS trial sites, and the relevant state or territory government in all other areas work closely with community health services to provide the following for those with FASD agreement on a standardised diagnostic tool; and provision of early intervention services and other health services such as speech pathology, physiotherapy and occupational therapy. Recommendation 11 6.32 The committee recommends that the COAG establish a joint taskforce for young people living in residential care. This taskforce will: • facilitate the development and implementation of integrated service pathways involving a range of portfolios at a state and federal level including housing, health, aged care, disability, and transport; and • facilitate the collation and development of information packs outlining support, transition and placement options for young people. These packs should be made available to young people, their families, health practitioners and other relevant professionals in hospitals and aged care facilities. This process should collate all information and tools developed by the states during the Younger People with Disability in Residential Aged Care (YPIRAC) program and lead to the development of a standardised national information pack and make available to all state and territory governments for deployment. 6.33 The joint taskforce will also be responsible for oversight of the following for young people living in a Residential Aged Care Facility (RACF): &nbsp;access to appropriate prescribed specialist services including speech pathology, physiotherapy, occupational therapy and other allied health services; the national rehabilitation strategy; the provision of advocates; the expanded key worker program; access to fully funded equipment as part of all state and territory Aids and Equipment schemes; • a cross sector approach is adopted to explore options for the provision of short term respite services; and • that all young people who indicate that they do not wish to live in residential care are transitioned into appropriate alternate accommodation by June 2018. Recommendation 12 6.34 The committee recommends that the joint taskforce issues a half yearly report on the progress of Recommendation 11 to the COAG

The challenge of managing continence care in residential aged care settings : recommendations for research and practice

Incontinence-related problems are a major reason for placement in residential aged care facilities. Data from the Residential Classification Scale indicates that 86% of people in residential aged care facilities in Australia are dependent on others for bladder management, 77% require some support with bowel management and 78% require some support with toileting. In this paper, we present an overview of the literature on the issues that need to be considered for the management of incontinence in residential aged care settings. Based on this literature, we make recommendations for research and practice. Although residential care facilities are mandated to provide continence care, there is little research evidence on which to base care or to evaluate the effectiveness of current practices. Further research is required to address this gap in information to ensure delivery of residential aged care that meets the requirements of the Aged Care Act 1997.<br /

Not truly partnerless: Non-residential partnerships and retreat from marriage in Spain

In Spain, nearly two-thirds of women aged 20-34 have not yet entered their first union. However, almost half of them have a stable partner in a different household. Hence, the drop in marriage rates and low prevalence of cohabitation cannot be rightly interpreted as a decline in partnership formation, but rather as a postponement of co-residential unions. This paper examines the prevalence and determinants of non-residential stable partnerships among young adults (women aged 20-34), in relation to cohabitation and marriage, using a multinomial logit model of current partnership type. The analysis is based on data from the 1999 Spanish Fertility Survey.cohabitation, LAT, partnerships, Spain, union formation

Working in Residential Aged Care: A Trans-Tasman comparison

Residential aged care has become an issue of critical interest in developed countries, including Australia and New Zealand, due to an ageing population and workforce. The ageing population has contributed to concerns about ensuring a sustainable labour supply to the sector. A key barrier to a sustainable workforce in residential aged care in Australia and New Zealand is the physically and emotionally demanding work, which is undervalued and low paid. This article compares the regulatory frameworks for residential aged care in New Zealand and Australia, and considers why, despite different environments, the outcomes for residential aged care workers are very similar. There is scant comparative research in residential aged care, particularly between New Zealand and Australia. This article provides an important overview of the regulatory environment in a sector that is increasingly important to the public, policy makers and researchers