The Australian Medical Journal (4 June 2018) published the findings of a innovative, complex and detailed investigation by Suzanne M. Dyer, Enwu Liu, Emmanuel S Gnanamanickam, Rachel Milte, Tiffany Easton, Stephanie L Harrison, Clare E Bradley, Julie Ratcliffe and Maria Crotty.

The paper, Clustered domestic residential aged care in Australia: fewer hospitalisations and better quality care, challenges the current perception of a residential aged care facility (RACF) and the role that it plays in the aged care sector.

For many people, moving into a RACF coincides with a reduced capacity for independence. Simply put, an individual is no longer safe living in their home, and needs care and accommodation.

It is how care and accommodation is offered, that is under scrutiny. There is an expectation of certain generational groups, mainly the Baby Boomers (1946 – 1965) within Australian society, that individual needs and preferences should be catered for.

There are many adjustments and unique challenges when moving into a RACF, that require sensitivity and a commitment from family and care givers, to ensure meaningfulness according to individual definition, is maintained.

The proposition is that an individual can still thrive through transition, and new models of care are needed to ensure that this occurs.

This concept while admirable, is not always practical or possible due to the complexity of care needs and the economic constraints in which many profit and not-for-profit organisations operate in.

Dyer,, propose the concept of smaller home-like environments accommodating up to 15 people, are a better option than larger facilities. While there is some empirical evidence to support this option, the report has been criticised for whether the participants were representative of the overall RACF population in Australia. Dyer,, examined 17 aged care facilities in four Australian states providing clustered (four) or standard Australian (13) models of residential aged care.

The conclusions reached by Dyer and her colleagues, was that clustered models of residential care are associated with better quality of life and fewer hospitalisations for residents, without increasing whole of system costs.

Aged care is complicated. As reflected in Joseph E Ibrahim’s response, Residential aged care: there is no single optimal model.  Ibrahim states that a RACF may accommodate subpopulations with differing trajectories, including people likely to stay for less than 12 months and those who require residential respite care, as well as a significant number of residents that die within six months of entry.

There may be a disconnect between a resident’s preferred model of housing and their individual health care needs. There is also the question of the organisational characteristics of the provider, including their philosophy, leadership, staffing profile, team dynamic, workplace culture and financial viability. Perhaps innovation or lack of innovation, also greatly influences the outcome of the experience for the resident.

While it would be wonderful for each resident to be supported with personal care, if and when they chose and had their meals, when they wanted, it is not practical in terms of current staffing allocations. And so the cyclic debate continues.

For access to these papers see here:

What is not in dispute is that quality care is an absolute. Quality care is more likely to occur with high-quality training from Registered Training Organisations, that don’t treat their students like a seat filler. That is the mandate at Corporate First Aid Australia.

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