Older people in the community

Older people in the community

Globally, the proportion of people aged 60 years and over is the fastest growing population group. Longer life expectancy and a decline in fertility rates are two factors that have contributed to this changing profile¹. The increasing numbers clearly present challenges for society in terms of how best to ensure maximum function, social participation and security for older people¹ but it is very important to recognise the success of public health policies and socioeconomic development already in place in supporting successful healthy ageing.  The World Health Organisation has developed 10 key facts on aging that should be read and carefully considered as they highlight the complexity of the global ageing population and the importance of investing in healthy ageing and ensuring that the workforce is appropriately trained in relation to ageing issues.

 

The Australian picture

In Australia one in seven people are over 65 years² with the number of people aged 85 and over also on the increase³.  It is anticipated that by 2047, almost one in four Australians will be aged 65 years and over⁴ and that by 2050, 3.5 million Australians will access aged care services, 80% of which will be delivered in the community³.  This increased demand for access to aged care services will result in many more career opportunities for health professionals in this sector.

 

Residential Aged Care

There is a strong community value placed on older people continuing to live in their own home or community for as long as possible and the majority of older people currently do just that. However, it is anticipated that the number of older people who are not able to look after themselves will quadruple by 2050¹ creating a need for increased care options.

When a person experiences significant decline in their ability to safely remain in the home setting then they may need to move into residential aged care. The decision making process associated with admission to residential care is complex and often occurs during a period of crisis for families as the desire of the older person to remain at home is often very strong. The process of making the decision and the move into residential aged care, therefore, is usually emotional and impacts on the carers or relatives just as much as the older person⁵.  Professionals involved in the decision making process need to be keenly aware of the psycho-social issues and highly sensitive when communicating with the individual and their family.

To determine if a person is eligible for residential care services an Aged Care Assessment needs to be undertaken. The Aged Care Assessment Team (ACAT) is made up of various professions including doctors, nurses, social workers and other allied health workers^6.  Their range of expertise and experience enables them to undertake an assessment from a number of different perspectives. A member of the ACAT will assess the individual’s situation taking account of the person’s medical needs, functional ability and available supports to determine if residential care is required.

The admission to a residential aged care facility can be a daunting and emotional process for the older person and their relatives/ carers, it requires skilful staff with highly effective interpersonal skills. There are many procedural and assessment matters that need to be undertaken at this point in time, when the new resident and carer are often feeling very vulnerable and anxious and it requires staff with highly effective interpersonal skills.

One aspect that is often highly confronting is having to determine advanced care directives. However, it is essential that everyone is aware and agrees on a plan of care that reflects what is important to the resident. To develop a deep understanding and some skills in how to approach such a sensitive topic carefully read the resources designed for professionals on the Advanced Care Planning website.

The availability of funding impacts on the type and frequency of services offered to residents, so it is important to understand government policies and funding mechanisms. In Australia, the Aged Care Funding Instrument (ACFI) is the resource allocation instrument used to determine care needs as a basis for allocating funding. The ACFI requires a full assessment of each resident upon admission to determine residential care subsidy the aged care provider can access for that resident. The ACFI assessment covers three components:

 

• Activities of Daily Living – ratings on nutrition, personal hygiene, toileting and continence
• Behaviours supplement – ratings on cognitive skills, wandering, verbal behaviour and depression
• Complex health care supplement – ratings on medication and complex health care procedure.

 

To further understand the mechanisms used to determine service provision and the associate practice requirements have a look at the ACFI User Guide and consider how important the assessment process is in determining the services that Mrs Collins will be able to access.
 

 

 

 

References

1. World Health Organization. Health topics: Ageing [Internet] 2014 [cited 2014 Feb 17]; Available from http://www.who.int/topics/ageing/en/
2. Australian Institute of Health and Welfare. Australia’s Health 2010: The 12th biennial health report of Australian Institute of Health and Welfare [Internet]. 2010 [cited 2014 Feb 17]; AIHW cat. no. AUS 142. Available from http://www.aihw.gov.au/publication-detail/?id=10737420537
3. Department of Health and Ageing. Living longer. Living better: aged care reform package [Internet]. 2012 [cited 2014 Feb 17]; Available from http://www.health.gov.au/internet/publications/publishing.nsf/Content/ageing-aged-care-reform-measures-toc.
4. Productivity Commission. Trends in Aged Care Services: some implications. Commission Research Paper [Internet].2008 [cited 2014 Feb 17] Available from http://www.pc.gov.au/__data/assets/pdf_file/0004/83380/aged-care-trends.pdf .
5. Gaugler J E, Mittelman M S, Hepburn K, Newcomer, R. Clinically significant changes in burden and depression among dementia caregivers following nursing home admission. BMC Medicine [Internet]. 2010[cited 2014 Feb 17]; 8(85) Available from http://www.biomedcentral.com/1741-7015/8/85