​​Barbara Barbosa Neves, Alan Petersen, Mor Vered, Adrian Carter, and Maho Omori

​​Monash University​

​​‘The aged care system is well behind other sectors in the use and application of technology’ noted the Royal Commission into Aged Care Quality and Safety in 2021. [1 p77] Yet, the Commission also warned that new technological systems and initiatives must ‘identify older people’s needs and preferences.’ [1 p147] 
 
Since the onset of the COVID-19 pandemic, we have seen a renewed drive to introduce emerging technologies, such as Artificial Intelligence (AI), into residential aged care. [2] This drive is fuelled by the promise that AI can help solve the systemic issues affecting the sector, being the ‘future of elder care’. [3] For example, robots and smart voice assistants can help stave off loneliness and social isolation; smart medical systems can improve clinical diagnoses; smart sensors can predict falls and health decline. And while AI can assist with some of these matters, we must examine its limitations and potential harms.   
 
Our new study, published in the Journal of Applied Gerontology, [4] aimed to understand how AI for aged care is imagined, designed, and implemented. For this, we conducted interviews with a range of stakeholders: AI developers, aged care staff, and aged care advocates in Australia. We explored their views about AI for later life, whether as developers of technologies for the sector or as those who have the power to implement or support their use in aged care settings.  
 
We found that, despite good intentions, developers made many promises about what AI could fix in aged care, from loneliness to staff shortages. But these promises were often made without considering the complexity of such environments and its residents. For instance, developers described stereotypical ideas about older residents. They were seen as a homogenous group and as technologically incompetent or disinterested. These ageist ideas illustrate how easily age-related bias can make its way into how we create AI technologies. But aged care staff and advocates held similar views about the technological incapacity or interest of older people. AI can be ageist by design but also by implementation.  
  
Our study shows that, alongside other prejudices pervading AI technologies like gender and racial biases, age is a serious but overlooked factor in research and policy. Understanding how ageism is embedded in both AI systems and in aged care settings is essential to combat it. This requires more institutional and public efforts to challenge simplistic narratives about older people. These narratives can lead to the development and application of technologies that exacerbate existing stereotypes and inequities, as they neglect the diversity of later life and the various needs and aspirations of older people. Indeed, their autonomy and dignity were rarely discussed across the stakeholders in our research. This was clear even when we were talking about AI for surveilling their everyday movements. Older residents were sometimes reduced to sick bodies to be constantly monitored.  
 
As stressed by the Royal Commission, ‘Ageism is a systemic problem in the Australian community that must be addressed’. [1 p75] We cannot forget to address it at all levels, including in relation to how we develop and use technologies for care. 

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Anna Lions

Communications Coordinator, Southern Cross Care (SA, NT & VIC) Inc

The Government-funded Short Term Restorative Care (STRC) programme helps older Australians to maintain their independence and keep living at home, but what happens when the eight-week program is over? Well, the answer right now, in many cases, is not enough.

A recent research grant funded by the Aged Care Research & Industry Innovation Australia (ARIIA) aims to help STRC participants continue to manage their health after the program ends. The grant is funding the development and trialling of a self-management workbook, My Health in My Hands, which participants will be guided through by Southern Cross Care allied health professionals.

The workbook includes evidence-based activities for setting health goals and learning about healthy activities, with a focus on the ongoing self-management of their health. Once the program has ended, participants can use the workbook for guidance on eating healthily, exercising, and looking after their wellbeing in a way that is both simple and the most beneficial to them.

The development of the workbook has included research into best practice methods, such as positive goal setting, and co-design with older people who have completed the STRC program. One co-design participant who is enthusiastic to see the workbook used is Peter Johnson. He completed the STRC program a few months ago and said he struggled without ongoing support and encouragement.

‘[The STRC program] gave me more confidence and encouragement as well as, and because of, my improved physical abilities,’ Mr Johnson said. ‘The team answered a lot of my questions during the program but I probably didn’t ask all the questions I needed to and at the end of the program I thought, “what happens now?”’ Mr Johnson said the workbook would have helped him to ‘design, plan and prepare’ for the gap between the end of the STRC program and the beginning of his home care services, in order to keep up his progress.

The workbook development is being overseen by healthy ageing expert Dr Tim Henwood, Group Manager Health & Wellness at Southern Cross Care (SA, NT & VIC) Inc. Dr Henwood is excited by the possibilities that this new workbook offers STRC program participants. ‘The workbook will offer all providers of short-term allied health and therapy programs a tool that clients can reference to learn and be more proactive about their own health,’ said Dr Henwood. ‘While we are trialling it in STRC, we hope it can play a key role in the forthcoming Government Support at Home reform by supporting older clients entering restorative pathways, to graduate from them with enhanced knowledge of how to best self-manage their health.’

The research partners are Justin Koegh, Associate Prof, Faculty of Health Sciences and Medicine at Bond University, and Dr Paul Swinton, Associate Prof at Robert Gordon University.

The first of the workbooks have now reached STRC participants. From here, the team will assess the impact of the workbook on participants’ health knowledge, wellbeing and allied health participation during and following their STRC program.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Dr Stephanie Champion

Research Fellow, ARIIA

Evidence is key for effective, innovative, health care practice and informed decision making. More than ever the Australian aged care sector needs evidence-based innovative solutions, to deliver cost-efficient care to meet the growing needs of an ageing population with complex needs and minimise the workloads of aged care workers.

Evidence-based practice (EBP) is defined as ‘an approach to care that integrates the best available research evidence with clinical expertise and patient values.’ [1] The promotion of EBP requires infrastructure and practitioners who support the implementation of evidence-based initiatives. The aged care industry has been comparatively slow to innovate. [2] Complex challenges, such as the shifting needs and expectations of multiple stakeholders, rising costs, and increasing regulatory pressure, among others, have been identified as barriers to innovation.

Moving forward, developing new ways of working now is vital for the long-term sustainability of the industry [3] and to take advantage of new opportunities, such as rapidly evolving technology. [2] The Royal Commission into Aged Care Quality and Safety highlighted the lack of strategy for implementing translational research outputs into practice while recognising that current funding structures fail to support providers who want to innovate. [4]

ARIIA’s Innovator Training Program (ITP) offers a practical pathway towards developing skills in designing implementable projects. Through the ITP, Innovators gain the knowledge and skills to implement innovative, evidence-based change in their setting.

A recent ITP project has achieved positive outcomes through engagement with the ITP. A clinical nurse from Round 1 of the ITP aims to implement an early intervention screening tool for delirium in residential care settings. Through ARIIA, she was connected with a research partner who has been able to help them find a screening tool and plan a pilot. According to this innovator, ‘I obviously came into the [ITP] not knowing how to even do a project or where to start… it's definitely given me like a base knowledge. I'd feel comfortable to start my own little project and know sort of the processes to make and ensure that it's evidence based and that I was on the right track with it.’

Are you working in the aged care sector and have a problem in your workplace? Do you need support to find a solution? The free Innovator Training Program is designed to provide you or your team with tools and skills to use available knowledge and evidence to solve a problem in your workplace.

If you’re interested in becoming an Innovator, please visit our webpage for more information: https://www.ariia.org.au/programs/innovator-training-program. While you’re there, check out our Innovator Essential Series mini-courses and get a sneak peek into our complete Innovator Training Program!

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Penny Neller, End of Life Law Toolkit Developer, End of Life Directions for Aged Care

End of Life Directions for Aged Care (ELDAC)

Voluntary assisted dying (VAD) is an emerging area for aged care in Australia. With VAD operating in all Australian States by the end of November 2023, aged care providers and staff will increasingly receive questions about VAD from those they care for and their families. Some common queries about VAD in aged care are discussed in ELDAC’s new FAQs factsheet and below. 

Is VAD legal everywhere in Australia?  
Every State in Australia has passed VAD laws. VAD is operating in all States except New South Wales, where it will start on 28 November 2023. VAD is currently illegal in the Territories. Each States’ laws are similar but there are key differences. 

Can anyone with a terminal illness receive VAD? 
No. To access VAD a person must meet all eligibility criteria in their State. This includes having:  

• decision-making capacity 
• a disease, illness or medical condition that will cause death within six months, or 12 months if the person has a neurodegenerative disease (such as motor neurone disease) or is in Queensland 
• a condition that is advanced and causing intolerable suffering. 

Can a person with dementia access VAD?  
A person will not be able to access VAD for dementia. This is because a person must have decision-making capacity to request VAD. A person whose dementia is so advanced that they are within 12 months of death will not have decision-making capacity. However, a person who is in the early stages of dementia and has a terminal illness (e.g., cancer) may be eligible for VAD if they have decision-making capacity and meet the other eligibility criteria. 

Who can request VAD? 
Only the person who will receive VAD. It cannot be requested by a family member, friend, substitute decision-maker, or aged care staff. A person cannot ask for VAD in their Advance Care Directive.   

How does a person access VAD?  
The process is different in each State. Generally, a person will need to make three requests for VAD and be assessed as eligible by at least two different medical practitioners who meet particular requirements.   
 
Can a person who asks for VAD also receive palliative care and other treatment?  
Yes. They can continue to receive palliative care and other medical treatment up until their death. 

Do health professionals and care workers have to participate in VAD? 
No. Healthcare professionals have the right to conscientiously object to participating in VAD. However, in some States they may still have legal obligations, such as to provide information to a person requesting VAD. Care workers can also choose not to be involved in VAD. 

Do residential facilities have to provide VAD? 
Residential facilities can decide whether to provide some, all, or no VAD services. However, in South Australia, Queensland and New South Wales residential facilities that choose not to provide VAD services still have legal obligations to enable a resident to access VAD if they wish.

Can health professionals and care workers discuss VAD or give information about VAD? 
Health professionals and care workers can provide information about VAD to a resident or others e.g., family if asked. However, there are restrictions on when healthcare professionals can start a discussion about VAD. Only some health professionals can do this, and in some States, they must provide certain information when they have discussions.  

Want to know more? Visit ELDAC’s End of Life Law Toolkit for everything you need to know about VAD in aged care. You can also download printable VAD factsheets for residential facilities (tailored to the State or Territory you work in) and different health professionals.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Kaele Stokes, Executive Director, Advocacy and Research

Dementia Australia

More than 400,000 Australians are living with dementia in Australia, while over 1.5 million people are involved in their care. Despite the numbers of people directly and indirectly impacted, community attitudes to dementia are still shaped by a lack of understanding about dementia, which means that our spaces, services, and attitudes are not always inclusive of people living with dementia, their families and carers. 

Dementia Australia recently published Half the Story, a free guide co-authored by people impacted by dementia for organisations to engage in meaningful consultation with people living with dementia, their families and carers. Half the Story offers information, tips and strategies for inclusive consultation which seeks out, affirms, and ratifies the voices of people impacted by dementia. The guide has been created to support organisations to set up their consultation process, refine their approach and increase the participation and engagement of people impacted by dementia.

As is detailed in Half the Story, meaningful consultation is necessary to understand the full story. This is best explained by a person living with dementia quoted in Half the Story who said, ‘You cannot feel what it is like inside our minds. Without us, you only have half the story.’

Half the Story is a go-to guide for understanding the full experience of people living with dementia, their families and carers. It explores the importance of meaningful consultation, various consultation approaches and how to consult in an accessible way. Many of the recommendations in Half the Story are based on the advice from people living with dementia, their families and carers who have had years of advocacy experience and would like to share it with organisations. 

Why engage in meaningful consultation? 
People living with dementia, families and carers have important things to say about life with the condition, their hopes for the future, and areas where better support is needed. Through consultation, you can identify opportunities for improvement and develop solutions together. Meaningful consultation respects people’s dignity and human rights, recognises knowledge and skills, amplifies the voices of advocates, and involves people in decisions that will affect their lives. 

What does meaningful consultation look like? 
Consultation becomes meaningful when we hear, respect, and act upon the ideas, opinions, and experiences (both good and bad) of people living with dementia, families and carers. It is a genuine invitation to shape the outcome of your project. Meaningful consultation thrives when those involved are positive and enthusiastic, are ready to listen with an open mind, people feel they can speak without judgement, when advocates know they have the genuine ability to influence a project and when there is demonstrated respect for advocates skill, knowledge, and abilities. 

Often people do not feel as though they are engaging in a meaningful consultation process when they are told things such as ‘it’s too late’ to make a suggestion, they are asked to approve a decision made by someone else, they do not feel the support of senior organisation leaders or something as simple as business acronyms being used but not explained. 

Well worth the work
Meaningful consultation may mean an organisation needs to work differently but it will be well worth it to those involved. Through meaningful consultation we can ensure people living with dementia can continue to participate within their own communities after diagnosis.  When we all know that a purposeful life can continue after diagnosis, the stigma of dementia can be lifted, and the discrimination faced by people impacted by dementia can be reduced. 

You can download Half the Story at dementiafriendly.org.au

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Dr Cathy Balding

​​Qualityworks PL; Australasian Institute of Clinical Governance; Adjunct Professor James Cook University

‘How can we engage staff in quality? (Or anything?)’ is a familiar refrain from quality managers, executives, and CEOs across human services, including aged care.

It’s impossible to create consistently good care unless staff – those providing the care and those supporting its delivery - are active and positive participants. And that this participation happens in partnership with consumers. But this is challenging to achieve when clinical governance compliance processes are presented to staff as ‘more work’, often without a meaningful ‘why’ or effective ‘how’. Despite the underpinning intent of clinical governance as a support system for staff to provide quality care, staff often experience it the other way around: that they exist to support clinical governance systems that are not useful, poorly implemented - or both. [1] This breeds disengagement and reduces clinical governance participation and point of care impact – which in turn reduces care quality and consumer satisfaction. In these days of rising expectations of care quality and the challenges of recruiting and retaining staff, it’s time to build a clinical governance bridge between staff and consumer satisfaction.

All staff have a direct or indirect role in point of care quality, from the executive through to line management.  This spotlight falls most brightly on managers, from executive to local, who create the conditions, make the decisions, and take the actions that determine how care happens every day. In fact, the quality of organisational and clinical leadership and management is a significant predictor of care quality. [2] However, this relationship is often overlooked in discussions on poor quality care and services, and few aged care middle managers appear to be purposefully equipped and supported to derive the satisfaction from their role required for them to have a positive impact on consumer care and satisfaction.  

We know that staff satisfaction is a predictor of consumer satisfaction, and yet the two are often addressed separately; sometimes one is even addressed at the expense of the other. But core components of staff satisfaction with their role, such as meaning, mastery, appreciation, autonomy and community [3, 4] can be built into the pursuit of quality care, building staff satisfaction through the act of pursuing quality care and higher satisfaction with consumers. This requires that executives: 

• define quality care with staff in a way that has meaning for everyone 
• implement compliance requirements as supports for staff to achieve quality care, rather than as ‘extra’ work with little meaning  
• equip middle managers to deliver quality care in their services, with commensurate recognition, so they, in turn, can support and recognise the efforts of their staff. [5]

These actions require no extra expenditure apart from focus and energy – and leadership. Compliance requirements supply most of the tools required to create quality care - it’s how we focus and use them to support staff that makes the difference.  In these days of searching for solutions to staff retention and consumer satisfaction, addressing them together has the potential to reap significant rewards for consumers,  staff and the aged care sector. 

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.