Caring for acutely unwell older residents in residential aged‐care facilities: Perspectives of staff and general practitioners

Abstract

From these findings it is possible to make recommendations for alternative ways of practising and/or new models of care.

Delivering inclusive and quality services in community and residential aged care settings

“…Several studies have assessed models for improving the aged care home to hospital nexus for better resident health outcomes . Evidence suggests there is a facility preference for managing health transitions in‐house for continuity and understanding of residents’ needs and functionality; however, facilities are often not equipped with the staff and resources needed to manage unwell residents .…”

“…Utilisation of this service depended upon the availability of timely and appropriate medical and nursing care in the aged care facility, and Residential InReach was used to complement or substitute the usual care available to residents . In comparison, when care coordination was organised through the Emergency Department there were more challenges in communication, referrals and transfers between locations than benefits to the resident . Facilitators of in‐house care included strong clinical expertise and support, and computerised medical records with connectivity to general practitioners .…”

“…Facilitators of in‐house care included strong clinical expertise and support, and computerised medical records with connectivity to general practitioners . However, there was also conflict between the wish to care for residents in‐house and concern about duty of care obligations and litigation . Models that overcome these barriers need consideration.…”

Abuse of the older person: Is this the case you missed last shift?

“…34 These are the most vulnerable older adults in society 32,35 and may become victims of mistreatment. [36][37][38][39] Although staff mistreatment in RACF environments still occurs, likely contributed to by poor wages, low staff-to-patient ratio, high staff turnover, inadequate training or supervision, 40,41 residentto-resident elder mistreatment is likely much more common. 38,42,43 Dementia and associated aggressive behaviours in RACF residents is high, 30,41 predisposing to verbal, physical and even sexual mistreatment between residents.…”

The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility

“…9-14 Residents and their families express a preference for care to be provided in their home 15 , and older people treated in these settings are less likely to experience complications commonly incurred during hospitalisation 6 16-18 . Previous studies have found that RACF nursing staff have a genuine desire to care for their acutely unwell residents within the facility 19-22 . There is therefore a strong clinical and economic basis for hospital avoidance interventions that promote appropriate nursing care within the RACF.…”