Exploring community-based aged care with Aboriginal elders in three regional and remote Australian communities : a qualitative study

While a small body of literature focuses on various facets of aged care services delivered to Aboriginal and Torres Strait Islander Elders, very little is known about the support needs and preferences of Indigenous Elders who ‘return to country’. This article addresses this gap. It explores the support needs of Indigenous Elders who return to their communities after having lived elsewhere for prolonged periods of time. It provides an overview of the key themes emerging from group sessions and semi-structured interviews with 11 Aboriginal Elders and 12 representatives of regional health and social care organisations conducted between 2012 and 2013. The article argues that the quest of Elders to strengthen kinship systems should not be seen as a barrier but as an opportunity to develop aged care services that resonate with the needs of Indigenous Elders and with their kinship network. The findings presented in the article are structured around the themes of empowerment and choice; community-based kinship care; and enhancing program flexibility. The article argues that it is crucial for Aboriginal community care services to be grounded in Indigenous culture. To address the wider socio-cultural project of Aboriginal Elders (i.e. to re-connect with their families, strengthen the kinship system and, re-create their cultural roles) when designing aged care services not only ensures that services are relevant to Indigenous Elders, it also ensures that services are culturally safe and address the psychosocial needs of Elders returning to country as well as their families. The article lends further weight to research that reports that a mainstream approach to the aged care of Indigenous Elder is likely to produce poor care outcomes

People at Centre Stage: evaluation summary report

This report presents the results of an evaluation of consumer-directed community aged care. Consumer-Directed Care (CDC) is central to the aim of rendering community aged care more flexible and responsive. In Australia, it builds on experiences of consumer-directed community-based disability care and is intended to offer greater decisional authority to care recipients over the services they receive. Since the 1990s, there has been growing interest among Australian community care providers, service users, and policy makers to ‘modernise’ and reform community aged care. A suite of reports were commissioned that highlighted the facts that: fragmented programme arrangements in community care create planning and operational difficulties and inefficiencies; the service provision model is too complex, making it difficult for lay people to access the services they need or are entitled to; funding gaps exist throughout the care pathways; the system is inflexible and unresponsive to transitions in people’s lives and/or illness trajectories; the needs of a significant minority of care recipients are not sufficiently addressed, resulting in poor quality of care as well as resource wastage. The People at Centre Stage (PACS) project aimed to address some of these issues. The aim of the project was to—within the limitations of current legislation and guidelines—develop, implement and evaluate a community aged care model that gives care recipients with more complex needs the option to have as much control of their own care as they aspire to and feel comfortable with. The project intended to offer a continuum of care ranging from customary case management to CDC. This summary report provides a brief outline of the results of this evaluation. It is structured in two parts: following a brief overview of the PACS model, Part 1 outlines the key findings from the quantitative analysis, while Part 2 offers an overview of the qualitative findings. Part 2 deals exclusively with the experience of people participating in the intervention group

Placement interviews at the interface of cultural diversity and standardised requirements

Field education placements permit social work students to gain practical experience employing the knowledge and skills they acquired in the classroom. Access to field education placements is dependent upon placement interviews during which candidates have to display their professional and personal suitability. Placement interviews are challenging for all students. For international students, they are particularly challenging as they represent a litmus test as to whether they have achieved a sufficient degree of cultural adaptation. To date, little attention has been paid to the way placement interviews are experienced by international students. This article addresses this gap. The article is based on a qualitative study involving semi-structured, in-depth interviews with five international students focusing on the way placement interviews were experienced, how students felt prepared for them, and the degree to which language proficiency, cultural difference, social connectedness, discrimination, and Australian workplace culture represented a challenge. The findings suggest that international students need be to better informed about opportunities associated with field placement and the often implicit requirements and expectations associated with it. The authors argue that they would benefit from targeted educational resources ranging from English language tuition to interview role play

Exploring Community-Based Aged Care with Aboriginal Elders in three Regional and Remote Australian Communities: A qualitative study

While a small body of literature focuses on various facets of aged care services delivered to Aboriginal and Torres Strait Islander Elders, very little is known about the support needs and preferences of Indigenous Elders who ‘return to country’. This article addresses this gap. It explores the support needs of Indigenous Elders who return to their communities after having lived elsewhere for prolonged periods of time. It provides an overview of the key themes emerging from group sessions and semi-structured interviews with 11 Aboriginal Elders and 12 representatives of regional health and social care providers conducted between 2012 and 2013. The article argues that the quest of Elders to strengthen traditional kinship systems should not be seen as a barrier but as an opportunity to develop aged care services that resonate with the needs of Indigenous Elders and with their kinship network. The findings presented in the article are structured around the themes of empowerment and choice; culturally appropriate care; enhancing program flexibility; case management; and systemic issues. The article recommends that (1) aged care services should work with and support Indigenous Elders in their efforts to strengthen traditional culture. (2) Aboriginal Elders eligible for home care packages should receive services that have the same flexibility and scope as those delivered under the National Aboriginal and Torres Strait Islander Flexible Aged Care Program (NPFACP). (3) A relaxation of funding guidelines and particularly around the issue of income substitution should be considered for Indigenous Elders. (4) Agency staff should be up-skilled (i.e. cultural safety, culturally appropriate interventions, referral options) and given the authority to support Indigenous Elders to address grief and loss issues in a culturally appropriate fashion. (5) Elders and their communities should be central to the decision making process underpinning their support arrangements and have shared control over services

Self-directed community aged care for people with complex needs: a literature review

This report critically reviews the literature on older care recipient‐directed care arrangements in the United States, United Kingdom, and Australia and highlights the importance to distinguish between Cash‐for‐Care and Self‐Directed Care schemes. Cash‐for‐ Care schemes typically involve the handing out of cash payments or vouchers to enable care recipients to purchase their own care instead of receiving in‐kind help at home. Ideally, Self‐Directed Care programs, on the other hand, are more holistic, care outcome focused and allow participants to choose among a continuum of care ranging from traditional case management approaches to cash options. Most of the reviewed literature focuses on Cash‐for‐Care schemes. However, as the more recent research suggests, Cash‐for‐Care programs may not provide the kind of choice that resonates with the preferences of many older people. Indeed, with the exception of Cash‐for‐Care schemes in California and Washington, programs were primarily aimed at and designed for people with disabilities. Most research indicates that Cash‐for‐Care programs generate either similar or better outcomes, especially in the domains of service satisfaction and self‐determination, with marginal detectable increase in risk, when compared with traditional agency‐directed services. Yet, the research also indicates that positive outcomes are directly linked to appropriate user supports. Care recipients who hire family members as carers derive extra benefit in terms of safety and service satisfaction