Barbara McKenzie-Green

A survey of people with intellectual disabilities living in residential aged care facilities in Victoria

BACKGROUND Australias national ageing policy recognises that people ageing with intellectual disability (ID) require particular attention, yet there is no policy framework concerning this population. This study describes the distribution and characteristics of people with ID in residential aged care in Victoria, provides insights into the pathways they take into aged care, and gives some indications of how facilities adapt to their needs. METHOD A postal survey was sent to 826 residential aged care facilities in Victoria, seeking information from directors about their residents with ID. Facilities that responded were fairly representative of all facilities in Victoria. FINDINGS Residents with ID were younger, had entered at an earlier age and remained longer than other residents. Their reported dependency profile was similar to the general aged care population, although the incidence of dementia was lower. Primary areas of concern identified by providers were: inability to fit into the resident community, lack of participation in activities and lack of meaningful relationships. CONCLUSION This study provides a first glimpse into how older people with ID find their way into aged care and how others view their experiences once there. It suggests that further investigation is required into the accuracy of assessment undertaken prior to entry to more clearly understand whether residents with ID are inappropriately placed in residential aged as a result of a shortage of disability accommodation and inadequate resources to support aging in place for those in such accommodation.

How Do Charge Nurses View Their Roles in Long-Term Care?

This article explores how registered nurses (RNs) in long-term care (LTC) understand their role as charge nurses. Data are derived from 16 charge nurses employed in 8 facilities in Ontario, Canada. Qualitative methods are used to analyze audiotapings of interviews. The findings reveal a range of dimensions and subdimensions. Charge nurses experience their work as highly complex and unpredictable. Themes that captured the following dimensions of the supervisor role in LTC include (a) against all odds, getting through the day; (b) stepping in work; and (c) leading and supporting unregulated care workers. In addition, analysis within each category reveals a complex intersection between the nurses’ perceptions of the context and their consequent work strategies. The emerging demands placed on supervisors due to the growing complexity of residents, increasing government regulations, and staffing shortages have caused the role of the charge nurse to evolve with little reflection on its impact.

Staff responses to age‐related health changes in people with an intellectual disability in group homes

The purpose of this study was to explore how supervisors in group homes caring for people with intellectual disability responded to the development of age‐related health changes in their residents. Ten group home supervisors working in the disability sector were interviewed once. Data were analysed using Dimensional Analysis. The study identified several factors related to whether a resident could stay ‘at home’ or would need to be moved to residential aged care (nursing home) including: nature and extent of group home resources, group home staff comfort with residents’ health changes, staff skill at navigating the intersection between the disability and ageing sectors, and the supervisor’s philosophy of care. The ability of older people with an intellectual disability to ‘age in place’ is affected by staff knowledge about and comfort with age‐related illnesses, staff skills at navigating formal services, staffing flexibility, and the philosophy of group home supervisors. Despite the growing international concern for the rights of people with disability, particularly in relation to decision making, questions about the older person’s choice of residence and participation in decision making about what was best for them, were almost nonexistent. Rather, decisions were made based on what was considered to be in ‘the best interest’.

Do gerontology nurse specialists make a difference in hospitalization of long-term care residents? results of a randomized comparison trial

Residents of long‐term care facilities have highly complex care needs and quality of care is of international concern. Maintaining resident wellness through proactive assessment and early intervention is key to decreasing the need for acute hospitalization. The Residential Aged Care Integration Program (RACIP) is a quality improvement intervention to support residential aged care staff and includes on‐site support, education, clinical coaching, and care coordination provided by gerontology nurse specialists (GNSs) employed by a large district health board. The effect of the outreach program was evaluated through a randomized comparison of hospitalization 1 year before and after program implementation. The sample included 29 intervention facilities (1,425 residents) and 25 comparison facilities (1,128 residents) receiving usual care. Acute hospitalization rate unexpectedly increased for both groups after program implementation, although the rate of increase was significantly less for the intervention facilities. The hospitalization rate after the intervention increased 59% for the comparison group and 16% for the intervention group (rate ratio (RR) = 0.73, 95% confidence interval (CI) = 0.61–0.86, P < .001). Subgroup analysis showed a significantly lower rate change for those admitted for medical reasons for the intervention group (13% increase) than the comparison group (69% increase) (RR = 0.67, 95% CI = 0.56–0.82, P < .001). Conversely, there was no significant difference in the RR for surgical admissions between the intervention and comparison groups (RR = 1.0, 95% CI = 0.68–1.46, P = .99). The integration of GNS expertise through the RACIP intervention may be one approach to support staff to provide optimal care and potentially improve resident health.

Occupational experiences of Korean immigrants settling in New Zealand

ABSTRACT For Korean immigrants, settling in New Zealand is challenging and stress-inducing. There is growing concern that feelings of alienation and loss seem to be key features in their lives. Taking the symbolic interactionism perspective that people interpret a situation through social interaction, the purpose of this study was to explore how Korean immigrants interact with their new environment, whilst re-negotiating their reality. A grounded theory methodology was employed as it places participants’ actions at the centre of its attention. Semi-structured interviews and field observations were conducted to collect information from 25 participants who lived in the North Island of New Zealand. Data were analysed using methods of constant comparison, conditional matrix and memoing. The resultant substantive grounded theory was Regaining Control: A Journey of Valuing Self. It offers one plausible explanation of how Korean immigrants make choices about their occupations by opting to enact ‘Korean Ways’ and ‘New Zealand Ways’ until they reach a place where they will once again feel valued as members of civic society. Through increasing understanding of the impact of immigration on occupations, this study contributes to knowledge of the diversity of human experiences in the occupational science literature.

Current role challenges in New Zealand aged residential care: the potential consequences for healthcare assistant role expansion

Background: Challenges facing healthcare assistants in aged residential care are a focus of global debate. These challenges involve remuneration, education, skill mix, work conditions and organisational structures. Objectives/Aims: We enter the discussion by acknowledging current work, education and remuneration for healthcare assistants. We then consider the supervisory relationships between registered nurses (RNs), enrolled nurses (ENs) and healthcare assistants, educational levels for RNs, ENs and healthcare assistants, and the interplay between organisation and practice in aged residential care. We suggest that improving work for the healthcare assistant has the potential to lead change in all role levels.Design: Discussion paper. Conclusions/Implications for practice: We argue that adjustments to work structures, education and skill advancement of RNs, ENs and healthcare assistants could improve staff working conditions and clarify practice boundaries. The ultimate result is likely to be an improvement to quality of care and the life of residents in aged residential care.