By Karly Bartrim

Aged care dietitian, academic (Griffith University), and PhD Candidate (University of Queensland)

Australia’s ageing population continues to place high strain on aged care services, urging the government to improve the system that supports older Australians to live and age well. [1] Strengthening the workforce that cares for older adults and increasing employment of allied health professionals are core recommendations continuing to be advocated for in media and by government today. [2] In addition, providing quality food that meets the nutrition needs of older adults and reducing malnutrition in these settings continues to be front of mind.

Dietitians are the only health professionals trained in providing nutrition care to prevent or reduce malnutrition and chronic diseases across all population groups. [3] Through the delivery of nutrition interventions, dietitians improve the health and wellbeing of older adults. This makes them an essential workforce for providing nutrition care in residential aged care facilities (RACF) and in-home services.

Dietitians’ roles and working hours vary worldwide. For example, in Ontario, Canada, dietitians have an allocated 30 minutes per resident per month to ensure Long Term Care Homes provide optimal nutrition care and ensure policies and procedures support older adults. [4] As such, Dietitians Australia have provided recommendations to introduce mandated dietitian hours in aged care to align with provinces in Canada and certain jurisdictions within the United States. To achieve this, the Australian dietetic workforce in aged care needs to increase substantially in size and capacity.

A greater understanding of dietitians’ attitudes when working with older adults in RACF or their homes can inform workforce strategies to support capacity-building initiatives that produce quality care. A recent integrative review was conducted, exploring dietitians’ attitudes working with older adults in these settings. [5] The review included studies from seven countries (the US, Canada, Australia, UK, Israel, Japan, and the Netherlands) conducted between 1986 and 2021. Twelve studies included dietitians working in RACFs, and five explored dietitians working within home care services.

Data from the studies were analysed and synthesised into five themes:

1. Recognising their contribution as dietitians
2. Lacking clarity about the boundaries of their role
3. All team members have a role to play in nutrition care
4. Assumptions and biases about working with older people
5. Needing to build capacity in the workforce.

Dietitians recognised the important contribution of their role in caring for older adults; however, they experienced low clarity about the boundaries of their role. Dietitians appeared to have positive and negative assumptions and biases about older people. Moreover, dietitians have recognised issues in the workforce, with not all team members prioritising nutrition care despite dietitians recognising all members have a role. Dietitians acknowledged that the dietetic workforce needs to build capacity through more time, funding, and professional development opportunities.

Future research is needed to understand dietitians’ confidence in their knowledge and skills regarding working in RACF and home care services to provide insight into future initiatives to support the growing workforce. Future directions need to include improving understanding of the dietitians’ role in aged care, incorporating practical opportunities for student dietitians in aged care, and considering the implementation of mandated dietitian hours. Integrating dietitian services and ensuring dietitians are well supported, will help improve the quality of Australia’s aged care system and improve the nutrition of older Australians.

*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 Priyanka Vandersman

Research Fellow, End of Life Directions for Aged Care (ELDAC), Flinders University

The aged care sector provides care and services to over 80% of Australians who are in the last year of their life, with statistics indicating that the residential aged care sector cares for over a third of all deaths. Following the Royal Commission into aged care 2018-2021, added demands have been placed on the already busy and fast-paced aged care sector. The need for greater reporting and transparency, high standards of care, and effective organisational processes has been placed on the sector forcing it to think of innovative approaches of care planning and delivery, including the care provided to those who are at the end of life.

One of the ways of ushering innovation into aged care is via use of advanced digital technologies to improve care outcomes. Indeed, prioritisation of technology integration into aged care, including the use of digital care management systems, is one of the recommendations of the Royal Commission, and in line with the  Department of Health and Aged Care’s Digital Transformation Agenda. As work continues at the systems level to address structural barriers to change, opportunities currently exist across the aged care sector to embrace strong leadership and foresight around digital technology to ensure that organisations are prepared to meet requirements in the future.

The Technology and Innovations stream of the End of Life Directions for Aged Care (ELDAC) project aims to support the aged care sector in utilising technology to improve their end of life and palliative care practices. Housed within the Research Centre for Palliative Care Death and Dying (RePaDD) at Flinders University, this stream of ELDAC has developed a number of digital health tools to support aged care services’ palliative care planning and provisioning processes, one of which is the ELDAC digital dashboard.

The ELDAC digital dashboard is a system application that aged care providers can embed as part of their IT systems. It is designed to track and visually represent key end-of-life care processes and indicators – supporting a consistent and comprehensive approach to end of life. One of the unique abilities of the dashboard is that it uses existing data that is captured within the service’s clinical data management system, processes it, and provides a one-stop shop for clinicians to graphically view and track all relevant care activities relating to their residents/clients. There is no need to feed data to the dashboard, which makes it ideal for integration into existing systems.

Since its development in late 2019, the dashboard has not only been integrated into the systems of four aged care IT providers/teams but has also been road tested in the real world with a rigorous implementation trial being conducted at 14 residential aged care sites across Australia. The results indicate a reassuring openness among the aged care workforce to engage with technology and a notable ability of the dashboard to help nurses organise end-of-life care, and support audit and compliance activities while promoting accountability in the EOL processes at the service level.

So, what does the dashboard experience tell us about technology for palliative care in the aged care sector? Firstly, it shows us that well-designed and carefully implemented digital tools can appropriately support staff and services in identifying and responding to an older person’s needs as they move into the last months, or year, of life. Secondly, the dashboard offers an interesting example of how new technologies can enhance the capacity of existing systems. Finally, the dashboard experience demonstrates that the aged care workforce is open to engaging with novel technologies, if these technologies have the potential to help them provide better end-of-life and palliative care to their older residents/clients.

The need for and rate of integration to IT within aged care is going to move rapidly in the next few years. Services will need to build workforce capability and look at how core work can be supported by digital innovations that have meaning for the workforce and the residents or clients. Technology providers and project leaders will need to ensure that technology products represent good value not only financially, but in terms of their value to aged care and their responsibilities.

*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.