Anna L. Howe

A profile of Australian family caregivers: diversity of roles and circumstances

Abstract: Research on family caregiving has been based largely on small samples, often drawn from support organisations or services, and has tended to focus on particular disability groups. Our study was population–based and included all ages and disabilities. As the first stage in a longitudinal research and health promotion program for informal caregivers, a statewide random survey of over 26 000 households was conducted by telephone: 78 per cent of self–identified carers (N= 976) agreed to participate in a one–hour interview. This paper presents a sociodemographic profile of Australian caregivers. Four types of relationship between carers and care recipients (adult offspring, spouses, parents and other relatives and friends) provide the framework for results. Group differences were observed on most characteristics: for example, age, living arrangements, work status and duration of care. Care recipient characteristics, including difficult behaviours and need for assistance, are also reported, as well as use of and need for community services. What the findings reflected most was the heterogeneity of both caregivers and care recipients and the diversity of caregiving roles and circumstances.

What's in a name? Similarities and differences in international terms and meanings for older peoples' housing with services

ABSTRACT The diversity of terms and meanings relating to housing with services for older people confounds systematic analysis, especially in international comparative research. This paper presents an analysis of over 90 terms identified in literature from the United Kingdom, the United States of America, Canada, Australia and New Zealand reporting types of housing with services under the umbrella of ‘service integrated housing’ (SIH), defined as all forms of accommodation built specifically for older people in which the housing provider takes responsibility for delivery of one or more types of support and care services. A small number of generic terms covering housing for people in later life, home and community care, and institutional care are reviewed first to define the scope of SIH. Review of the remainder identifies different terms applied to similar types of SIH, similar terms applied to different types, and different terms that distinguish different types. Terms are grouped into those covering SIH focused on lifestyle and recreation, those offering only support services, and those offering care as well as support. Considerable commonality is found in underlying forms of SIH, and common themes emerge in discussion of drivers of growth and diversification, formal policies and programmes, and symbolic meanings. In establishing more commonality than difference, clarification of terminology advances policy debate, programme development, research and knowledge transfer within and between countries.

Migrant Care Workers or Migrants Working in Long-Term Care? A Review of Australian Experience

Discussion of the role of migrant care workers in long-term care (LTC) that has gained increasing attention in the United States and other developed countries in recent years is of particular relevance to Australia, where 24% of the total population is overseas-born, two-thirds of them coming from countries where English is not the primary language. Issues of interest arise regarding meeting LTC workforce demands in general and responding to the particular cultural and linguistic needs of postwar immigrants who are now reaching old age in increasing numbers. This review begins with an account of the overseas-born components of the aged care workforce and then examines this representation with reference to the four factors identified as shaping international flows of care workers in the comparative study carried out for the AARP Public Policy Institute in 2005: migration policies, LTC financing arrangements, worker recruitment and training, and credentialing. The ways in which these factors play out in Australia mean that while overseas-born workers are overrepresented in the LTC workforce, migrant care workers are not identifiable as a marginalized group experiencing disadvantage in employment conditions, nor do they offer a solution to workforce shortages. The Australian experience is different from those of other countries in many respects, but it does show that the experience of migrant care workers is not unique to LTC and points to the need to extend the search for solutions to workforce shortages and improving conditions of all care workers well beyond LTC systems to wider policy settings.

Caregiving: a common or uncommon experience?

The analysis reported here aims to establish the household prevalence of caregiving in Australia, drawing on a large scale, longitudinal survey conducted as part of the Victorian Carers Project. Comparisons are made with a national survey conducted by the Australian Bureau of Statistics and with Canadian and U.K. findings. Three aspects of caregiving are investigated: reported household prevalence, taking account of differences in definitions used in various surveys; the extent of intergenerational exchanges involved in caregiving; and the time dimensions of caregiving, in terms of duration and patterns of cessation of caregiving over time. A high degree of consistency is found in prevalences of caregiving and implications for the development of policies and programs to support caregivers are raised concerning levels of caregiving, approaches to identifying carers, targeting of services and promotion of caregiving, and the spread of the experience of caregiving across the lifecycle and between generations.

Work satisfaction and intention to leave among direct care workers in community and residential aged care in Australia.

Turnover in the Australian aged-care workforce is lower than in the United States but is still of concern. This research examined the effects of worker satisfaction, worker characteristics, work conditions, and workplace environment on intention to leave, using data from a 2007 national census of the aged-care workforce. A probit model was used to estimate the probability of care workers leaving their jobs in the next 12 months. While workers were satisfied, overall, with their work, improving some components of satisfaction and converting casual contracts to permanent work would reduce intention to leave. To these ends, a shift in focus is required away from worker characteristics and the nature of care work to job conditions and organizational matters amenable to management and policy action.

Recent Developments in Aged Care Policy in Australia

Summary A series of major reforms implemented through the mid 1980s sought to contain residential care and expand community care in Australias long-term care system. While this goal has been maintained, a number of new policy initiatives followed the change of federal government in 1996. This article presents a systematic account of current policy objectives, implementation measures, and outcomes in three major policy areas: changing the balance between residential and community care, targeting in community care, and support for family caregivers. This analysis shows that while there have been shifts in emphasis from time to time, concerted policy efforts over the last 20 years have contained the growth of expenditure on long-term care and realized significant change in the service system.

From states of confusion to a national action plan for dementia care: the development of policies for dementia care in Australia.

The release of Australias National Action Plan for Dementia Care in 1992 was the culmination of more than a decade of policy development over which the federal government assumed an increasing role, and the participatory approach fostered under its Social Justice Strategy promoted collectivist and political attempts to address the issues of dementia care. This article begins with an account of four phases of policy development, with the transition from one to the next marked by changes in thinking about dementia care being incorporated into policy and then expressed in programmes and in care practices. In the second part of the article, the goals and structure of the National Action Plan are outlined and its implementation and outcomes discussed. Continuation of the policy climate in which the National Action Plan was formulated is a crucial, but uncertain, factor for future development.

The role of sanctions in Australia's residential aged care quality assurance system

OBJECTIVE To assess the role of sanctions as the highest level of enforcement in Australias residential aged care quality assurance (QA) system. DESIGN ANALYSIS of secondary data on accreditation activities and outcomes from 1999-2000 to 2007-08, extracted from the Annual Report on the Aged Care Act 1997. SETTING A total of 138 sanctioned homes among all aged care homes in Australia (n = 2830 in 2007-08). MAIN OUTCOME MEASURES Chi-square test of differences between sanctioned and non-sanctioned homes, and z scores to identify variables underlying differences. RESULTS Sanctions are a rare event as more frequent enforcement actions at lower levels of regulatory action mean that a diminishing number of homes are subject to higher levels of action. Relationships between the risk of sanctions and characteristics of homes (state, size, sector and level of care) were evident. Sanctions provide only limited signals on quality to potential users and do not reflect the full scope of the QA process and the range of quality of care found. CONCLUSIONS The effectiveness of sanctions in contributing to quality improvement has to be seen within the wider regulatory framework, which in turn has to be set in the context of other factors driving quality of care. Quality improvement in Australia and elsewhere will depend on further development of QA systems but will also require attention to wider contextual factors that contribute to quality outcomes, including quality of the aged care workforce.

GERONTOLOGY IN AUSTRALIA: THE DEVELOPMENT OF THE DISCIPLINE

The development of gerontology as a discipline is traced in this article following Rosenbergs framework for analyzing the ecology of knowledge. The history of the institutional arrangements for the conduct of gerontological education and research is reviewed to set the background for a detailed analysis of gerontological knowledge. The sources used are twenty years of proceedings of the annual conferences of the Australian Association of Gerontology, a recent review of Australian gerontological literature appearing in local and overseas journals, and two editions of a national directory of research on aging. This analysis investigates three areas of gerontological knowledge: content, indicated by the topics of research; structure, indicated by the disciplinary backgrounds of the researchers; and organization, indicated by the institutional contexts in which research and educational activities have taken place. In the concluding discussion of the implications of the current state of gerontological knowled...

International Comparisons of Long-Term Care: Australia

This account of nursing home care in Australia begins with a brief history of four phases of policy development from 1963 to the early 1990s. The structure of the nursing home system is then outlined; particular attention is given to data sets generated from administrative systems that are used for monitoring nursing home care. Arrangements for pre-admission assessment and assessment of resident dependency and care needs, to which reimbursement levels are related, are described next. A profile of resident characteristics and their patterns of utilization of nursing home care is presented, drawing on these assessment data. Policy issues arising in the 1990s are addressed in the conclusion; these concern the place of nursing home care in the overall balance of aged care services and the enhancement of outcomes of nursing home care in regard to quality of care and workforce training. Finally, the contribution of the continuing development of data sets for monitoring trends and outcomes to policy and program development is noted.