Professor Lee-Fay Low

Faculty of Medicine and Health, University of Sydney

I am tremendously excited that ARIIA is offering research partnership grants to improve aged care in Australia. Unfortunately, at the moment it’s a really challenging time to be planning and undertaking research in aged care. I’ve been an aged care researcher for 20 years, and the conditions make it really, really difficult. Here are some of the problems that my teams have been facing. If you have solutions, please share them. Tweet @leefay_low and we can keep this conversation going.

COVID-19 was a huge disruption to research

 With ongoing workforce issues exacerbated by COVID-19, aged care organisations have had extremely limited bandwidth for research since 2020.  Many aged care research partner organisations have had markedly less capacity to participate and contribute, despite a strong commitment to the projects. We have paused or downsized projects because aged care staff could not help with our research. I personally feel like some projects have lost momentum in terms of showing efficacy or being ready to scale.

Current aged care reforms make rigorous relevant study design harder

At the time of writing, the new Aged Care Act is passing through Parliament. There will be major changes to the way that home and residential care is structured, funded and regulated, but policies and programs have not been finalised yet.

This means that some observational data we collect now might be less relevant after reforms (e.g., why do home care clients ‘save’ so much of their budget). It also means that long intervention studies (e.g., a 12-month staff practice change randomised trial rolled out over 2 years) might be confounded by system-wide changes. As we write our grants for funding for 2023 and beyond, it is trickier to design a potential impactful, competitive-for-funding project.

Implementation of aged care reforms will continue to occupy the aged care sector 

Implementation of aged care reforms will likely result in strategic changes in aged care organisation priorities. Executive teams and managers will be busy working to implement changes required by the reforms, and providers are likely to continue to have reduced bandwidth to collaborate on research over the next few years. We need to figure out how to reengage our aged care partners.

What can aged care researchers do?

In planning future grants, we’ve started to think about research that might be useful in terms of implementing or evaluating the reforms. We are also talking to aged care providers and policymakers about the research questions most of interest to them. We may need to budget in more support for aged care organisations if we want our research projects to be feasible.

We shouldn’t strive to conduct easier research projects; we should strive to conduct research projects which answer important real-world questions. I believe it is critical that right now we should be conducting research that answers questions about how to improve aged 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.
 

Dr Claire Gough

Research Fellow, ARIIA, Flinders University

‘Rehabilitation, reablement, and restorative care’ were recently identified as high-priority issues by the Australian aged care industry. It was therefore surprising that Australian rehabilitative aged care resources were difficult to find. An initial review of the literature suggested that agreement on a single definition of rehabilitation is problematic and perhaps a contributing factor. The Australian Government Department of Health has stated that medical rehabilitation ‘involves the diagnosis, assessment, and management of disability due to illness or injury.’ [1] This definition varies significantly from the World Health Organisation’s (WHO) definition of rehabilitation as a set of interventions ‘designed to optimise functioning and reduce disability in individuals with health conditions in interaction with their environment.’ [2]

In discussing this difference with our Expert Advisory Group (EAG), the issue of defining rehabilitation was considered more significant than a simple variation in terminology. It was perceived by the EAG that the disparity was also evident between professional bodies and therefore healthcare professionals who often work together closely in aged care. For example, physiotherapists and occupational therapists consider that rehabilitation should include optimising function and reduction in disability for individuals with health conditions. However, the applicability of definitions was particularly unclear in the context of aged care settings across Australia.

A more pertinent issue for Australian aged care is perhaps that service users residing in the community were much more likely to receive rehabilitation than those living in residential aged care facilities. At present, Australian aged care focuses on terms such as ‘dependency’ and ‘deficit’ to justify funding. Yet these terms can act as a disincentive to embed the rehabilitative approach of ‘progression’ and ‘improvement’ into aged care services. [3] Despite the Australian Government providing funding and subsidies for restorative care and reablement services, rehabilitation is funded by the Australian health care system. The issue, therefore, lies in the Australian Government’s ‘Care and services in aged care homes guidelines’ which emphasizes that aged care providers cannot charge a resident for rehabilitation programs or assessments (Item 2.6 Rehabilitation support). [4] This has prompted much debate as to whether older adults residing in residential care services are entitled to receive rehabilitation following acute injuries such as a hip fracture, [5] or whether this is viewed as ‘double dipping’ from multiple funders.

Despite the issues around defining what rehabilitation entails across varied settings and the issues around access and funding, the call for rehabilitation to be expanded throughout aged care services in Australia continues [5]. Integrating rehabilitation throughout aged care services therefore requires deeper consideration, exploration, and involvement from providers, service users and aged care advocates to inform change.

*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.

Xanthe Golenko, Anna Fowke, Georgina Johnstone, Judy Lowthian

Bolton Clarke

Stories are central to human connection, communication, and cognition. They are integral to our culture and identity and enable us to learn, celebrate, heal, and remember.

Storytelling is a powerful way of giving voice to people who may be unheard or invisible. Its transformative nature helps people make sense of experiences in their lives and empowers them to reflect, respond and react. It links us together with others and with things that are important to us.

Life story work is an intervention that has been conducted in residential care homes to support personhood and promote person-centred care. It is recognised for providing residents with an opportunity to share and reflect on their life experiences, which can validate their sense of self and value as an individual. It also provides the opportunity for care home staff to get to know residents on a deeper level and see their individuality and uniqueness, which can enhance the quality of interactions and relationships. Building strong relationships can help create a sense of belonging and connectedness, which can reduce feelings of loneliness and social isolation.   
While the benefits of life story work in aged care are well recognised, it is often underutilised due to barriers including time constraints on staff, and potential risks and concerns about evoking painful memories. In response, Bolton Clarke has developed a storytelling program for residential aged care and is trialling an innovative approach to implementation that addresses resource constraints and maximises benefits for all. 

The Bolton Clarke Storytelling Program explores and celebrates the stories and life learnings of residents through group work (story circles) and individual story projects (life story books, posters and digital stories). It is designed to facilitate choice and inclusiveness while catering to the diverse needs and preferences of individual residents. The program is underpinned by a trauma-informed practice framework that draws on SAMHSA’s six trauma-informed principles: Safety and security; Trustworthiness and transparency; Peer support; Collaboration and mutuality; Empowerment, voice and choice; Cultural, historical and gender issues. [1]
Implementation of the Storytelling Program is guided by Meyer’s Implementation Framework for Aged Care [2] to support program fidelity and sustainability. A key component of the implementation strategy is partnering with universities to give health and aged-care workforce students the opportunity to participate in the storytelling program in student placements. The benefits of such partnerships are three-fold:

1. It minimises the burden on the workforce to undertake story work projects with individual residents but enables all care home staff to participate in group sessions; 
2. It gives students the opportunity to participate in a meaningful and rewarding activity with older adults; 
3. It helps develop positive attitudes toward older adults and attracts future workforce to residential aged care.

The program is being evaluated using a Type 3 Hybrid effectiveness-implementation design which permits testing of the implementation while gathering information and observing the effectiveness of the Storytelling Program with a focus on reducing loneliness and social isolation.

*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.

James Stack

Managing Director
Obvious Choice

Susan Boyle is best known for her unexpected success on the show ‘Britain’s Got Talent.’ When she arrived on stage during her audition the audience and the judges were cynical. Everyone had decided what to expect from the 47-year-old, unemployed spinster based on their own personal biases. Susan surprised everyone. Boyle’s rendition of ‘I dreamed a dream’ paved her way to becoming one of the most talked-about and successful performers in the show’s history.

Before Boyle won the world over in 2009, she devoted much of her life to caring for her ailing mother, who died in 2007 at the age of 91.

Over the last year, an increasing number of personal care workers from some of Australia’s most trusted aged care provider brands showed us that unexpected success doesn’t only happen on talent shows. These continuous learners, ranging in age from their early twenties through to their late fifties, participate in microlearning campaigns across topics including dementia care, infection prevention and control, and the serious incident response scheme. For some of these learners, Tagalog is their native language, for others Malayalam or Hindi. Some have only recently learnt English as an Additional Language.

Using a mobile app called Forget Me Not, these personal care workers engage with a new way of learning that delivers frequent five-minute ‘challenges’ most days of the week. Each challenge engages the learner in a text-based conversation and gets them to practice the delivery of safe quality care with virtual older Australians.

The ‘little and often’ approach is backed by neuroscience and research on optimal training delivery techniques. Providing personal care workers with more repetition strengthens memory muscle and makes knowledge recall likely in the moment of need.

Many of these personal care workers developing a daily microlearning habit using their mobile phones aren’t digital natives (a term created by Marc Prensky). These people haven’t grown up in the digital age, in close contact with computers, the Internet, mobile phones, social media, and tablets. Most of them were digital immigrants (people who have had to adapt to the new language of technology). Some were digital refugees (people whose jobs, livelihoods, and lives have been disrupted by the rapid advance of information technology, automation, and artificial intelligence). I sometimes encounter objections from management when I suggest personal care workers can and will embrace a more convenient, accessible, evidence-based approach to their professional development that recognises and rewards mastery of job role knowledge.

Managers are sometimes cynical about personal care workers’ ‘potential’ and propensity for continuous learning, much like the judges on the British talent show. This cynicism is often based on their experience of getting personal care workers to complete eLearning or attend classroom training.

However, much like Susan Boyle, these personal care workers surprise everyone. These busy workers embrace the chance to learn regularly using their mobile phones (rather than occasionally on a computer or in a training session), with most of them finding ways to fit the learning into gaps within their daily schedule. Some enjoy the opportunity to learn from home. All of them find a way to fit some learning into their day at a time and place that best suits them. They revel in the flexibility, the freedom, and the recognition.

Learning is often its own reward but in this case, the learning also results in knowledge mastery leading to a sense of confidence that builds better outcomes for everyone in these people’s care.
 

James Stack is the Managing Director of Obvious Choice, an award-winning learning design and technology firm. His team developed the Forget Me Not microlearning app used by forward-thinking aged care providers committed to better staff training using evidence-based approaches.

 

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.