Cheryl Tilse

Restoring and Sustaining Home: The Impact of Home Modifications on the Meaning of Home for Older People

ABSTRACT The importance of a supportive home environment to successful aging has been well-established in the literature, with home modifications increasingly acknowledged as ways of removing barriers to function and increasing independence for older people. Home modification literature and practice primarily focus on the home environment as a physical space in which to perform tasks and on the impact of modification on competencies and function. Home, however, is much more than a physical environment. Within a transactive framework, people and places are seen as engaged in a dynamic, reciprocal relationship through which home becomes a place of significant personal meaning. Through a qualitative framework, this study examines the experience of older people living in the community who are recipients of a home modification service. It explores the impact modifying the physical environment has on their experience of home as a place of meaning and provides insight into how home modifications can strengthen the home as a place of personal and social meaning as well as improve safety and comfort for the older person at home.

Referral to rehabilitation following traumatic brain injury: a model for understanding inequities in access

Identifying inequities in access to health care requires critical scrutiny of the patterns and processes of care decisions. This paper describes a conceptual model, derived from social problems theory, which is proposed as a useful framework for explaining patterns of post-acute care referral and in particular, individual variations in referral to rehabilitation after traumatic brain injury (TBI). The model is based on three main components: (1) characteristics of the individual with TBI, (2) activities of health care professionals and the processes of referral, and (3) the contexts of care. The central argument is that access to rehabilitation following TBI is a dynamic phenomenon concerning the interpretations and negotiations of health care professionals, which in turn are shaped by the organisational and broader health care contexts. The model developed in this paper provides opportunity to develop a complex analysis of post-acute care referral based on patient factors, contextual factors and decision-making processes. It is anticipated that this framework will have utility in other areas examining and understanding patterns of access to health care.

Older people and their assets: A range of roles and issues for social workers

Abstract Following a 10-year research program around assets and ageing, the present paper summarises the work done, and outlines the major findings from the perspectives of older people, carers, and service providers. The research has explored the roles and practices of family caregivers in managing older peoples assets, the experiences of older people who receive such assistance, the factors associated with the financial abuse of older people with and without cognitive capacity, and the concerns of aged care practitioners when the mismanagement of assets is suspected. The experiences of older people and their carers are characterised by a range of responses that generate a number of issues for social work practitioners. Taking a critical perspective, the article discusses practice responses in relation to financial abuse, the assessment of the capacity of the older person to make decisions, and assisted and substitute decision making around asset management.

Prevalence and predictors of advance directives in Australia

Advance care planning is regarded as integral to better patient outcomes, yet little is known about the prevalence of advance directives (AD) in Australia.

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.

Evaluating communication for resident participation in an aged care facility

Speech pathologists who work in aged care facilities are often challenged to find appropriate measures of communication that consider the frailty of residents and the policy environment that speech pathologists are required to work within. This article describes a process for evaluating resident participation in an aged care facility (ACF) using the framework of the World Health Organizations International Classification of Functioning, Disability and Health (ICF). It also presents the findings of this process from one ACF, a 60-bed high care facility. Assessments of individual residents communication impairments, activity limitations and participation restrictions were conducted initially, followed by evaluations of the physical and social communication environment of the facility. At the individual level, residents were found to have a high prevalence of communication impairments and reported activity limitations and participation restrictions associated with these. The environmental assessments identified that residents had few opportunities to communicate, and that the physical and social environment was not conducive to communication. This study supports many others that have found a high prevalence of communication disabilities in residents of ACFs. It also confirms that the communication environment is not conducive to participation and recommends assessments for identifying both resident and facility-wide communication problems.

Access to assets: older people with impaired capacity and financial abuse

This paper draws upon findings from a secondary analysis of suspected financial abuse cases in files of the Guardianship and Administration Tribunal in Queensland, Australia. The paper explores the association between formal and semi‐formal asset management arrangements and suspected financial abuse cases. The role of families as formal asset managers is also considered.

Financial Capacity in Older Adults: A Review of Clinical Assessment Approaches and Considerations

Financial capacity is a critical issue of autonomy for older people. However, determining the point at which a cognitively impaired older adult is no longer capable of independent financial management poses an onerous task for family members, and health and legal professionals. At present, there is no agreed-upon standard for evaluating financial capacity, and issues pertaining to the level of impairment that constitutes incapacity remain largely unresolved. In the absence of validated assessment guidelines, determinations of capacity are frequently based on neuropsychological measures and clinical judgment, although there is limited evidence to support the validity of these methods in capacity determinations. In this paper, various cognitive, psychiatric, social, and cultural factors that potentially contribute to financial incapacity in older adults are described. The strengths and weaknesses of clinical approaches and instruments currently used in capacity determinations are evaluated, and specific recommendations are made regarding broader assessment approaches. Finally, directions for future research and instrument development are offered.

Referral to post-acute care following traumatic brain injury (TBI) in the Australian context.

The study aimed to describe the types of care allocated at the end of acute care to people diagnosed with TBI and to identify the factors associated with variations in referral to care. A retrospective analysis of medical records of 61 patients was conducted based on a sample from two hospitals. While 60.7% of the study sample were referred to formal rehabilitation care, this was primarily non-inpatient rehabilitation care (32.8%). Discriminant analysis was used to determine medical and non-medical predictors of referral. Results indicated that place of treatment and age contribute to group differences and were significant in separating the inpatient rehabilitation group from the non-inpatient and no rehabilitation groups. Review by a rehabilitation physician was associated with referral to inpatient rehabilitation but was not adequate to explain referral to non-inpatient rehabilitation. An in-depth exploration of post-acute referral is warranted to improve policy and practice in relation to continuity of care following TBI.The study aimed to describe the types of care allocated at the end of acute care to people diagnosed with TBI and to identify the factors associated with variations in referral to care. A retrospective analysis of medical records of 61 patients was conducted based on a sample from two hospitals. While 60.7% of the study sample were referred to formal rehabilitation care, this was primarily non-inpatient rehabilitation care (32.8%). Discriminant analysis was used to determine medical and non-medical predictors of referral. Results indicated that place of treatment and age contribute to group differences and were significant in separating the inpatient rehabilitation group from the non-inpatient and no rehabilitation groups. Review by a rehabilitation physician was associated with referral to inpatient rehabilitation but was not adequate to explain referral to non-inpatient rehabilitation. An in-depth exploration of post-acute referral is warranted to improve policy and practice in relation to continuity of care following TBI.

Older people's assets: a contested site

The management of the financial assets of older people is increasingly important in the current policy context. Competing interests from the state, the market and the family regarding the appropriate use of these assets suggest that non‐professional managers are assisting older people in a complex environment. This paper, based on a national prevalence study and an in‐depth study, explores the nature and extent of asset management on behalf of older people. It examines the role of legal provision for substitute decision‐making in these processes and concludes that the current provision is insufficient to protect older people from financial abuse and support carers to manage assets well. This paper proposes that more broadly based interventions are required in a complex environment of competing interests. Such interventions include attitudinal change, improved financial literacy, information and support for older people and informal asset managers and improved monitoring and support for substitute decision makers.