Heat-Ready: heatwave awareness, preparedness and adaptive capacity in aged care facilities

AbstractThis study identifies the current policies and strategies Australian ACFs use to keep residents well, and highlights the barriers to heatwave adaptation and maintaining wellness in the residential aged during periods of extreme heat. As the Australian population ages, planning for the health effects of extreme heat in elderly residents is critical to ensure wellness in this population group is maintained.Aims were to: 1) investigate current heat-wave planning, policies, staff knowledge and heat prevention strategies and 2) identify barriers to adaptation and successful implementation of adequate heat-wave health care in ACFs in three Australian states (NSW, Queensland and South Australia).Residential ACFs were identified across three states using Department of Health and Ageing databases, white pages and internet searching. After removal of duplicates, 1,561 facilities were invited to participate in the study. Each participating facility was asked to provide informed consent and invited to select one administrative and one clinical staff member to participate in a 15 minute Computer Assisted Telephone Interview (CATI). Participants were asked about their knowledge of the effects of heat on the elderly and to detail current plans and policies which addressed residents’ health during heat-waves, and barriers to care during periods of extreme heat. Data was entered into a purpose-built database and analysed using Statistical Package for the Social Sciences (SPSS) Version 19.Two hundred and eighty seven (287) facilities (18%) participated in the telephone interview. The ACFs enrolled represented 20,928 Australian aged care residents.  Ninety percent of facilities had a current ACF emergency plan, although only 30% included heat-wave emergency planning. Heatwave policies were not routine in all ACFs in any state. Staff used a range of strategies to keep residents cool in extreme heat, although strategies were not consistent across all states or facilities. The issues raised in relation to clinical care in this group can be synthesised into four key messages; cooling, hydration, monitoring and emergency planning, which, at a practical level are essential to maintain the health of older people in very hot weather.Please cite this report as: Black, DA, Veitch, C, Wilson, LA, Hansen, A 2013 Heat-Ready: Heatwave awareness, preparedness and adaptive capacity in aged care facilities in three Australian states: New South Wales, Queensland and South Australia, National Climate Change Adaptation Research Facility, Gold Coast, 47 pp.AbstractThis study identifies the current policies and strategies Australian ACFs use to keep residents well, and highlights the barriers to heatwave adaptation and maintaining wellness in the residential aged during periods of extreme heat. As the Australian population ages, planning for the health effects of extreme heat in elderly residents is critical to ensure wellness in this population group is maintained.Aims were to: 1) investigate current heat-wave planning, policies, staff knowledge and heat prevention strategies and 2) identify barriers to adaptation and successful implementation of adequate heat-wave health care in ACFs in three Australian states (NSW, Queensland and South Australia).Residential ACFs were identified across three states using Department of Health and Ageing databases, white pages and internet searching. After removal of duplicates, 1,561 facilities were invited to participate in the study. Each participating facility was asked to provide informed consent and invited to select one administrative and one clinical staff member to participate in a 15 minute Computer Assisted Telephone Interview (CATI). Participants were asked about their knowledge of the effects of heat on the elderly and to detail current plans and policies which addressed residents’ health during heat-waves, and barriers to care during periods of extreme heat. Data was entered into a purpose-built database and analysed using Statistical Package for the Social Sciences (SPSS) Version 19.Two hundred and eighty seven (287) facilities (18%) participated in the telephone interview. The ACFs enrolled represented 20,928 Australian aged care residents.  Ninety percent of facilities had a current ACF emergency plan, although only 30% included heat-wave emergency planning. Heatwave policies were not routine in all ACFs in any state. Staff used a range of strategies to keep residents cool in extreme heat, although strategies were not consistent across all states or facilities. The issues raised in relation to clinical care in this group can be synthesised into four key messages; cooling, hydration, monitoring and emergency planning, which, at a practical level are essential to maintain the health of older people in very hot weather.&nbsp

Barriers to the use of Information and Communication Technology by occupational therapists working in a rural area of New South Wales, Australia

Background/aim: This qualitative study formed part of a large-scale, multi-phase study into the delivery of therapy services to people with a disability, living in one rural area of New South Wales, Australia. The study’s purpose was to identify the impact of information and Communication Technology on the workforce practices of occupational therapists’ working in a rural area of New South Wales. Methods: Individual semi-structured telephone interviews were conducted with 13 occupational therapists working in disability, health and private practice in a rural area of New South Wales. Participants were asked about access to, skills and limitations of using Information and Communication Technology. A modified grounded theory approach, based on thematic analysis and constant comparison,was used to analyse the interview transcripts. Results: This study found widespread use of technology by rurally based occupational therapists working in the disability sector in New South Wales. However, Information and Communication Technology was primarily used for client contact, professional development and professional networking rather than therapy provision. The study identified individual, workplace and community barriers to greater uptake of Information and Communication Technology by this group. The individual barriers included: age cohort, knowledge and personal preferences. The workplace barriers included: support and training and availability of resources. The community barriers included: infrastructure and perceptions of clients’ acceptance.Conclusion: The potential exists for Information and Communication Technology to supplement face-to-face therapy provision, enhance access to professional development and reduce professional isolation thereby addressing the rural challenges of large distances, travel times and geographic isolation. To overcome these challenges, individual, workplace and community Information and Communication Technology barriers should be addressed concurrently

Rural GP's management of vehicle related trauma

Background: There is twice the morbidity and mortality resulting from vehicle related trauma in rural and remote areas than in metropolitan areas. Little is known about Australian rural general practitioners' management of those affected. Methods: Seventeen rural GPs in North Queensland participated in semi-structured interviews for this exploratory study of the management of patients presenting with acute or chronic vehicle related trauma. Responses were analysed quantitatively and thematically. Results: General practitioners reported more presentations of chronic than acute vehicle related trauma. Common injuries were soft tissue injury, whiplash and chronic pain syndromes. Vehicles most often involved were motorbikes, passenger cars and bicycles. Surgeons and physiotherapists were the most difficult service providers to access. Better coordination of rehabilitation and community support services is required. Discussion: General practitioners in rural North Queensland manage patients with chronic vehicle related trauma without adequate access to specialised rehabilitation services. More training of GPs and practice staff and improved coordination of these services are required.</p

Health policy: understanding outcomes for rural maternity care

Aims and rationale: Despite government commitments to improve rural residents' access to health services, 42% of rural maternity units throughout Queensland have closed over the last 10 years. Such closures raise concerns about equity of access and quality of maternity care for rural communities. There is little literature available which discusses the impact of health policies on rural residents' experiences of accessing maternity care, or the experiences of the health professionals who provide these services. The aims of this study are twofold: (a) critically review government health policies relevant to rural maternity care; and (b) investigate the correlation between health policy discourse and the lived experiences of rural communities in providing and accessing maternity services. Approaches: Relevant Commonwealth and Queensland health policies were identified and critically reviewed. A case study approach was then used to explore the lived experiences of both providers (midwives, GP proceduralists, hospital administrators) and users (community members) of maternity care in four rural, north Queensland towns. Data comprised documentary evidence, interviews with service providers and focus groups with community members. Findings: The reduction of rural maternity services was found to have profound, multifaceted effects on local communities. Lived experiences and policy-related outcomes are discussed within four topic areas: workforce; community engagement; quality and safety of care. Benefits to the community: Understanding policy outcomes for rural maternity units should inform the development of future health policies. Recommendations are aimed at enhancing maternity care provision and access in rural communities

Informing Evidence-Based Health Policy for Rural Australia

NHMRC and Department of Human Services NSW, Ageing, Disability and Home Car

Engaging rural communities health policy

Aims & Rationale: The Alma-Ata Declaration espouses participation as a right for all citizens and important in the provision of primary health care. Australian health policy discourse encourages citizen engagement, but the extent to which this actually occurs remains unclear. Citizen engagement potentially offers considerable benefits for rural communities – a population with known health disadvantages. Drawing on results of a research project exploring the health policy implications for rural maternity care, this paper aims to (a) discuss the extent of community participation found in four rural north Queensland towns; and (b)consider how policy discourse around citizen engagement may be applied to rural health policies. Methods: Case studies of four rural north Queensland towns were completed. Observational, interview and documentary data were collected and qualitatively analysed via an inductive thematic technique. Findings: The case studies provided little indication of formal mechanisms through which community members could provide input to local health service delivery. Two communities demonstrated rapid mobilisation to rally and apply political pressure when their health services were threatened, but a distinction must be made between community action and true engagement processes. While mindful of the benefits, interviewees at all sites were particularly concerned about the barriers to successful community engagement, including: (i) overcoming community scepticism; (ii) concerns about representativeness; and (iii) community capacity. Benefits to the community: For rural communities, citizen engagement may have particular advantages in enhancing the appropriateness and responsiveness of local health services. Recommendations are made for improving rural communities' input to health policies which affect them

Health policy and rural health services: using qualitative methodologies in policy analysis

Background: Equity, access, safety and quality are prominent themes in rural health policies at a national level. These policies often contain objectives around improving rural health services and the health status of rural Australians. It is important to consider whether these objectives are being met for rural populations to discern the appropriateness of current policies and the potential need for changes in policy approach. Objective: To understand the influence of policy on provision of, and access to, rural maternity care. Design: Analysis of policy and case studies. Setting: Four north Queensland rural towns. Participants: (a) Rural residents who recently accessed maternity care; and (b) health care professionals involved in the provision of maternity services including midwives, procedural medical practitioners and GPs. Main outcome measures: Identification of predominant themes in government policies that relate to rural maternity care and identification of outcomes for local maternity services. These findings were supplemented by insights to rural citizens’ experiences in accessing maternity care and rural clinicians’ experience in providing care. Results: The findings indicate a dearth of specific policies to support the development and continuation of rural maternity care services. Conclusions: Without detailed policy support for rural maternity care, services at each of the four case study towns appeared more vulnerable to the effects of other non-specific policies and negative environmental factors

Health policy: outcomes for rural residents’ access to maternity care

Regular health care during pregnancy, birthing and the postnatal period is recommended for improving maternal and neonatal outcomes and accessing such care has become a common expectation for Australian families. Studies have highlighted the relative safety of birthing in rural hospitals even though these units are typically associated with low volumes of deliveries. Yet, in Queensland, the location and number of public maternity units shows a clear trend towards centralisation of services. During 1995- 2005, 43% of Queensland public maternity units closed, with the remaining units predominantly located in coastal and more populated locations. The closure of rural maternity units is not restricted to Queensland: the National Rural Health Alliance estimated 130 rural maternity units had closed across Australia throughout the decade 1996-20065. Growing numbers of closed rural maternity units raises considerable questions regarding the care accessed by rural residents. This paper presents findings from research conducted in north Queensland which examined the impact of health policy on an issue that is of central importance to rural communities—access to birthing services. A multi-dimensional understanding of access to maternity services was adopted in this study, a view which goes beyond measuring access only in terms of geographic distance. Gulliford et al have provided a constructive discussion of the multifaceted nature of access, particularly the differentiation between ‘having access’ and ‘gaining access’ to health care. Having access implies that a person has the opportunity to use a health service if they need or want it. This type of access is often measured in terms of doctors or hospital beds per capita and is dependent on the provision, and geographical allocation of resources, as well as the actual configuration of the network of health services. The authors draw attention to Mooney’s proposition that equal costs in using a service (eg costs of care, costs of travel, lost work) indicates equal access to services. On the other hand, gaining access to health care can be complicated by a variety of barriers including those of a personal nature (eg patients recognising their need to access health care); financial (that is, costs to be borne by the potential patient) or organisational (eg waiting lists)

Issues affecting therapist workforce and service delivery in the disability sector in rural and remote New South Wales, Australia: perspectives of policymakers, managers and senior therapists

Introduction: The disability sector encompasses a broad range of conditions and needs, including children and adults with intellectual and developmental disabilities, people with acquired disabilities, and irreversible physical injuries. Allied health professionals (therapists), in the disability sector, work within government and funded or charitable non-government agencies, schools, communities, and private practice. This article reports the findings of a qualitative study of therapist workforce and service delivery in the disability sector in rural and remote New South Wales (NSW), Australia. The aim was to investigate issues of importance to policy-makers, managers and therapists providing services to people with disabilities in rural and remote areas. Methods: The project gathered information via semi-structured interviews with individuals and small groups. Head office and regional office policy-makers, along with managers and senior therapists in western NSW were invited to participate. Participants included 12 policy-makers, 28 managers and 10 senior therapists from NSW government agencies and non-government organisations (NGOs) involved in providing services and support to people with disabilities in the region. Information was synthesised prior to using constant comparative analysis within and across data sets to identify issues.Results: Five broad themes resonated across participants’ roles, locations and service settings: (1) challenges to implementing policy in rural and remote NSW; (2) the impact of geographic distribution of workforce and clients; (3) workforce issues - recruitment, support, workloads, retention; (4) equity and access issues for rural clients; and (5) the important role of the NGO sector in rural service delivery and support. Conclusions: Although commitment to providing best practice services was universal, policy-related information transfer between organisations and employees was inconsistent. Participants raised some workforce and service delivery issues that are similar to those reported in the rural health literature but rarely in the context of allied health and disability services. Relatively recent innovations such as therapy assistants, information technology, and trans-disciplinary approaches, were raised as important service delivery considerations within the region. These and other innovations were expected to extend the coverage provided by therapists. Nongovernment organisations played a significant role in service delivery and support in the region. Participants recognised the need for therapists working for different organisations, in rural areas, to collaborate both in terms of peer support and service delivery to clients

Some recent radio talks.

Salt movement in soils - By T. C. STONEMAN, B.Sc. (Agric), Adviser, Soil Conservation Service Although this subject may sound rather remote from practical farming, it is, never- theless, a field of study which has a most important bearing on the measures used in the handling and reclamation of salt-affected country. Pastures and disease - By J. CRAIG, M.R.C.V.S., Senior Veterinary Surgeon If we were to ask the man on the land what his purpose was in farming, we would probably get many different sorts of answers. But certainly an answer common to each, would include, in general terms, a desire to farm his land to its potential, build up his livestock numbers and maintain them in positive health. Spring budding of citrus - By H. S. ARGYLE, Horticultural Instructor A horticulturally-inclined member of the fair sex, recently sought information regarding the mysteries of budding citrus trees. Of course, she said, I know that the top part grows from a bud, but where do you get the bit at the bottom? The citrus white fly - By C. P. H. JENKINS, M.A., Government Entomologist White flies or snow flies are tiny insects easily recognised by their short rounded wings and the white flocculent powder which covers the entire body. Several native species exist in Western Australia and they may be found feeding upon gum leaves and various bush plants, but fortunately they have not turned their attention to cultivated crops. In some parts of the world, however, white flies cause considerable damage and attack such things as citrus, tomatoes and other vegetables. Drives for fox destruction - By A. G. VEITCH, Supervising Vermin Control Officer The Agricultural Protection Board has received a number of requests from branches of the Farmers\u27 Union throughout the agricultural areas, for assistance in organising fox drives in their respective areas prior to the lambing season. It would be as well to say som