The recent changes in funding for aged care have made me think more laterally about the way we treat our elderly residents. For too long within the Aged Care setting we have continued to function under and subscribed to the traditional medical model, where care is led by GPs or nurses, with allied health professionals having little control over the treatment pathways for residents. In many ways, the existing ACFI structure and in particular the pain management program in its current form, has fed into this, with physio treatments being used to tick funding boxes, instead of making the most of our training and skills to the benefit of residents.
Surely it is time to adopt a more holistic approach, where we are assessing and treating the whole person rather than managing specific symptoms and problems. For those with dementia, disability or disease we need to look at the person behind the diagnosis and consider their mind, their body and their spirit.
Patient centred approach is proven effective
A consumer directed care (CDC) approach is being advocated for Australian home care services and with the new Accreditation Standards set to have a more targeted focus on CDC, perhaps the long awaited change in now coming. Carers, medical staff and allied professionals are all being encouraged to actively engage with each individual, working out what is important to them, before planning a care strategy to help them achieve these goals. Don’t residents in care facilities deserve the same level of choice and control? I think we would all agree they do, we just need the appropriate funding model to help support this type of care model, a move away from the traditional episodic or diagnosis payment to a more proactive per capita payment maybe a more cost effective way to fund services.
A research paper in Ireland showed that a patient-centred approach was vital for the health and happiness of residents. Choice, privacy and a sense of identity were some of the key things that elderly residents valued for a good quality of life. In the study, it was clear from interviews with the residents, that having varied activities and therapies enhanced their wellbeing and increased engagement. The lead researcher Dr Adeline Cooney from the National University of Ireland, Galway, said
“This study highlights the importance of providing a holistic, person-centred approach that goes beyond satisfying the technical and procedural aspects of care. Care staff should regard the quality of life of residents as an integral part of their role and residents and their families should have significant input into how services are structured and delivered. Although this study was carried out in Ireland, the basic principles of how the quality of life of older people in residential care can be enhanced are universal.”
She’s right, the geography is irrelevant. Elderly residents, whether they’re from Galway or the Gold Coast will all respond to care that is responsive, targeted to their individual needs and that takes into account their personal goals and wants. In my experience, after years of supporting and treating elderly Australians a more holistic approach can lead to significantly improved function and wellbeing. A government report has supported the use of a holistic and consumer directed care approach in residential aged care facilities, but how can we make it happen?
Making use of the talent available
Allied professional like physios and OTs have the training, experience and expertise to provide this care, so why isn’t it happening? Our allied health clinicians are currently not being utilised to their full potential and as such this acts as a deterrent and negatively impacts recruitment and retention of high quality staff within the industry. Physio and OT’s can play a vital role as primary health practitioners within what is a generally deskilled work environment, owing to financial squeeze. Health literacy is crucial to ensuring that a true client centred model of care is delivered and this relies heavily on each member of the multi-disciplinary team having a healthy appreciation for each others role and skill sets and effectively engaging these at the appropriate times within continuum of care.
As a trained professional, it is frustrating not to utilise all of our abilities- but more importantly it means that residents are short changed and don’t get the full potential therapeutic benefit. We can make a difference, whether it’s personalising daily activities, choosing specific exercises and therapies to maximise fun and function, treating pain or facilitating reablement we can look beyond the patient and help the person live a life that is comfortable, fulfilling and enjoyable. Now we just need to find a way to educate everyone in the government and the care industry, so that we are able to fulfil this potential.
