Aged Care and Occupational Therapy Concerns

• Occupational Therapy Australia (OTA) submitted information to the Royal Commission into Aged Care Quality and Safety in September 2019.
• OTA is the professional association and peak representative body for occupational therapists in Australia
• There were approximately 22,000 nationally registered occupational therapists in Australia as of June 2019.
• Occupational therapists are allied health professionals who enable clients to participate in meaningful and productive activities.
• Occupational therapists provide physical and mental health therapy, vocational rehabilitation, chronic disease management, assistive technology assessments etc
• Occupational therapists provide healthcare to people across all ages, including older Australians.

Role of Occupational Therapists in Aged Care

• Enhance health and wellbeing and preserve, restore, enable and/or improve function and independence

• Assess and modify consumers' homes and community environments to enable aging in place

• Prescribe aids, equipment, and home modifications to increase safety and minimise falls

• Prescribe adaptive strategies and provide education for maintaining/improving mobility, independence and function

• Provide prevention, assessment and management of chronic disease

• Provide health and wellbeing services specific to change across the lifespan

• OTA supports occupational therapists working in aged care, especially as demand rises with Australia's aging population.

• Some therapists have become disillusioned with Residential Aged Care Facilities (RACFs) due to varied care standards.

• Occupational therapy should improve independence, maximize function, and maintain quality of life.

• Occupational therapy in RACFs is often focused on pain management and pre-determined care for funding purposes

• Older people can engage in personally meaningful activities, regardless of their condition.

• Health includes activity, participation, personal factors and environmental factors.

Importance of Evidence

• The aged care sector needs standardized data to track care in facilities.
• Data should measure active participation, quality of life, user-satisfaction, the incidence of pressure injuries, medication errors, unexplained weight loss, falls, infection rates, admissions to hospitals, staffing levels and training.
• OTA supports disclosure of staffing levels.
• Transparency is essential for evidence-based consideration of RACFs
• Accreditation and compliance frameworks need to be evidence driven with adequate resourcing for timely data collection.
• Aged care systems need positive outcome measures.
• RACFs should be subject to the highest accreditation standards like healthcare environments.
• The new Aged Care Quality and Safety Commission's Aged Care Quality Standards were introduced on 1 July 2019.

Concerns Around the Aged Care Funding Instrument (ACFI)

• Companies hiring occupational therapists/physiotherapists for pain management tend to hire new graduates and have high staff turnover rates.
• Jobs involve high client volume with massages or transcutaneous electrical nerve stimulators (TENS), with pressure to meet daily quotas.
• OTA received complaints about the suitability of the ACFI system.

Clinical and Managerial Workforce

• Increased demand exists for occupational therapists to provide pain management but they can't implement their full range of treatment modalities due to ACFI guidelines and RACF management.
• Therapists report being promised experience across a range of skills, but the job involves only using hand massagers, and managers persuade residents to accept it.
• Some therapists are employed to deliver pain management programs for extra ACFI funding, roles do not allow occupational practice, and they are asked to work 'out of scope.'
• Occupational therapists do not have the scope to make interventions relevant to clients.
• Occupational therapists use modalities common to other disciplines, but the occupational therapy contribution to pain management is the occupational analysis and occupational adaptation approach.
• Use remediation strategies like massage, TENS, ultrasound and acupuncture alongside other modalities.
• The aim is to enable the older person to be comfortable and engaged in purposeful activity, and to minimise pain using non-pharmacological methods.
• ACFI guidelines are too narrow and do not support therapeutic engagement.
• Clients with dementia are disengaged
• Poulos et al, 2017, recommend a reablement approach in dementia.
• Concerns are raised that ACFI is not aimed at improved or sustained quality of life.
• Residents are therefore deprived of goal or function-directed therapy.
• Occupational therapist skillsets can assess all care needs and reduce hospital readmissions.
• Multidisciplinary care teams in all facilities are needed to provide a range of options for residents and reduce hospital admissions from residential aged care.
• Staff focus should be on maximizing client occupation.
• Aging should be, to the greatest extent possible, an activity.

Clinical Care Planning

• An important aspect of clinical care is adopting a holistic approach as occupational therapists contribute to skill maintenance, capacity building, reablement and the improvement of health and well-being.
• Areas of care planning that are contrary to the wellness approach may contribute to decline in health, increased staff needs, and overall care costs.
• Aged care facilities should clearly specify duties and responsibilities and investigate false claims regarding opportunities to gain experience.
• Interventions and modalities funded should be expanded to take the broad scope of occupational therapy practice into account.
• Choice of treatment modality should be clinically determined as occupational interventions may be more beneficial.
• Aged care facilities should invest in consumer-focused aged care teams that include allied health professionals.

Abuse of Older Australians in Residential Aged Care Facilities

• OTA welcomes the Council of Attorneys-General National Plan to Respond to the Abuse of Older Australians 2019 – 2023.
• Elder abuse needs elevation as a policy priority and OTA welcomes the establishment of this Royal Commission.
• A state-based approach is fragmented and inconsistent. Lack of coordination has prevented elder abuse agencies from sharing best practice research and knowledge.
• The National Elder Abuse Conference provides a forum for information and knowledge sharing, but doesn't allow agencies to engage in ongoing long-term strategy discussions.
• A state-based approach lacks consistency in terms of service and resource availability.
• Many initiatives should be included as part of a national elder abuse prevention and response strategy:
• An interagency taskforce.
• A national advertising campaign to raise awareness, promote support services, and provide reporting information.
• A central access point for legal frameworks, investigative processes and police powers.
• Better resourcing of existing Commonwealth departments and agencies.
• Funding for peer support networks

Examples of Elder Abuse

• A veteran with dense stroke had a leg amputated due to poor care, short staffing leads to pressure injuries.
• Nursing home residents are being excluded from activities so they become isolated.
• Residents are sometimes discouraged from walking so they remain in bed all day.
• Poor hygiene and moldy cups, compounded by residents being unable to communicate such issues.
• Residents are often sedentary and exercise programs do not engage them in physical activity instead of watching a DVD only.
• Families who privately pay for care should have access to more tailored programs.
• A coordinated approach to preventing abuse should be at a national level.

Reporting Requirements and Privacy Concerns

• Staff in RACFs obligated to report falls to the Clinical Manager, but not to a higher authority.
• Addressing privacy concerns for use of video surveillance in residential aged care facilities is important, to make sure incidents like what happened in South Australia where a staff member suffocated a resident are not repeated, and that the staff member being later convicted of aggravated assault
• OTA called for the use of video surveillance in private rooms of aged care facilities provided it is appropriate
• Permission from residents or family members/guardians must be obtained with indicative feedback and time frames.
• States and territories should enact mandatory reporting legislation.
• Video surveillance should be allowed in private rooms with permission.
• All aged care facilities should publicly display a notice on how to report complaints.

Understaffed Facilities

• Chronic understaffing is the most pertinent factor contributing to poor standards of care despite adequate funding.
• Lack of occupational therapists and allied health professionals
• Staff are often inexperienced and underqualified with no registration body overseeing PCAs.
• Residents have falls/fractures or are bedbound due to a lack of care.
• Staff are required to perform tasks that are not within their clinical role e.g. brushing residents' teeth.
• Understaffing leads to a lack of proper attention being paid to the needs of residents and a lack of patience being shown by staff with an absence of a registered nurse
• A registered nurses are needed to carry out treatments on each shift, especially with the increase in palliative care clients.
• Greater resident engagement is needed. Facilitate mobilisation to eliminate pressure injuries/prevent falls
• Clients who are disruptive or have behavior problems should get more individual diversional therapy.
• Therapists are best placed to oversee assistive equipment.
• Legislative requirements must be put in place for one registered nurse at all times in residential aged care facilities
• Diversional therapy programs must be individual needs tailored in residential aged care facilities

Quality of Staff Training

• Inadequate staff training is a key cause of abuse and poor clinical practices.
• Aged care staff may not have sufficient knowledge for people with dementia or cultural competency.
• Offer adequate training to staff members for whom English is a second language is necessary because Australia Australia is actively seeking RACF workers to these backgrounds to support residents.
• Current graduate supervision mentorships is inadequate with staff shortages
• Privately funded/community-based facilities lack funding for clinical governance supervision
• Inadequate training supervisory lack professional development = neglect
• Occupational therapists note that training is not regularly maintained with nursing assistant staff resulting in equipment mis-use that needs major piece of equipment and annual updates
• New grads that are working in aged care should attend meets regularly with supervisiors
• Staff in Orgs - must do refresher training in clinical experience
• Direct care should have mandatory training in trauma to address signs of abuse.

Accreditation standards for residential aged care

• It is unclear what levels of knowledge staff in RACFs have of the quality standards for aged care.
• Key question occupational therapy perspective, how therapist will have to meet these standards when facilities are on a needed basis
• Quality review processed should be strengthened through responsible type of compliance including professional/clinical resources
• For Oakden facility in Adelaide, there reports found a lack of occupational therapy services meant expert input sought.
• The single set of aged care quality standards commencing July 1st 2019 will ensure patient quality of life
• There is a wide care scope but the standards alone aren't clear enough on clinical care including allied health.
• Reward good practice - share commission of the information in a safeguard.

Complaints Mechanism

• Older people in resi care can have evidence limited to no awareness and limited complains that older person can become the target for intimidation to the Royal Commission

Chemical and physical resitraint management to behaviors

• It is vital to minimise measures of restrictive practices based in assessment and care planning.
• Understanding olde people's needs such as pain infection and incontinence is crucial minimising distress
• training experience of care staff improves quality care
• the majority of residential aged care manages medications problems arise from regular review in excessive work loads
• medication is on based on nursing reports should include access to education training safe
• funding on non pharmacological person intervention - including occupational therapy

Home Care Packages

• To help to access a home, must be better organized but can confuse most consumers

• Assessors and care service will spend explaining correspondence and HCP - it cannot succeed until capacity to educate is reached.

• More assessors needed by priority - changes are fought by assessor consumers to get package

• ACAT should help with negotiate. service will be delivered. some OTA members report it has previously become slower.

• a trial consideration given for service. to be liable and be difficult in trans population. to level 4 package can provide

• Not enough reablement and should implement new strategies.

• process would be with assess the new potential for care in the in the home.

• teams based care team based with trained works.

Other objectives on Aged care

• the right services at the moment not response independently - assessors are confusing - the RAS to help manage
• to improve design is needed by modification improvement

This quiz covers key issues in aged care, focusing on concerns raised by Occupational Therapy Australia (OTA). Topics include the Aged Care Funding Instrument (ACFI), pain management services, funding utilization, and data collection needs within Residential Aged Care Facilities (RACFs). It also covers elder abuse.