Chapter Twelve: The Marketisation of Aged Care: The Impact of Aged Care Reform in Australia

Henderson, Julie; Willis, Eileen

doi:10.1007/978-981-32-9208-6_12

Cited by 14 publications

(20 citation statements)

References 27 publications

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“…High administrative burdens accompany policy and service redesign on the ground [ 10 ]. These phenomena can obstruct service providers from being able to engage with processes that build and equip future workforce/s – both current and emerging [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Co-designing a methodology for workforce development during the personalisation of allied health service funding for people with disability in Australia

Foley

Attrill

Brebner

2021

BMC Health Serv Res

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Background Internationally, health and social services are undergoing creative and extensive redesign to meet population demands with rationed budgets. This has critical implications for the health workforces that serve such populations. Within the workforce literature, few approaches are described that enable workforce development for health professions in the service contexts that emerge from large scale service redesign in times of industry shift. We contribute an innovative and robust methodology for workforce development that was co-designed by stakeholders in allied health during the personalisation of disability funding in Australia (the introduction of the National Disability Insurance Scheme). Methods In the context of a broad action research project, we used program logic modelling to identify and enact opportunities for sustainable allied health education and workforce integration amidst the changed service provision context. We engaged with 49 industry stakeholders across 92 research engagements that included interviews (n = 43), a workshop explicitly for model development (n = 8) and a Project Advisory Group (n = 15). Data from these activities were inductively coded, analysed, and triangulated against each other. During the program logic modelling workshop, we worked with involved stakeholders to develop a conceptual model which could be used to guide trial and evaluation of allied health education which was fit-for-purpose to emerging workforce requirements. Results Stakeholder interviews showed that drivers of workforce design during industry shift were that (1) service provision was happening in turbulent times; (2) new concerns around skills and professional engagement were unfolding for AHP in the NDIS; and (3) impacts to AHP education were being experienced. The conceptual model we co-designed directly accounted for these contextual features by highlighting five underpinning principles that should inform methodologies for workforce development and AHP education in the transforming landscape: being (1) pedagogically sound; (2) person- or family-centred; (3) NDIS compliant; (4) informed by evidence and (5) having quality for all. We use a case study to illustrate how the co-designed conceptual model stimulated agility and flexibility in workforce and service redesign. Conclusions Proactive and situated education of the emerging workforce during policy shift is essential to realise future health workforces that can appropriately and effectively service populations under a variety of changing service and funding structures – as well as their transitions. We argue that collaborative program logic modelling in partnership with key stakeholders including existing workforce can be useful for broad purposes of workforce (re)design in diverse contexts.

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Section: Introductionmentioning

confidence: 99%

Co-designing a methodology for workforce development during the personalisation of allied health service funding for people with disability in Australia

Foley

Attrill

Brebner

2021

BMC Health Serv Res

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“…The historical landscape of Australian residential aged care sector following reforms in 1997 has been heavily characterised by the privatisation of the sector. An absence of public transparency among providers is said to have perpetuated systemic issues exacerbated by the lack of staffing requirements and minimal funding accountability (Henderson & Willis, 2020). Similar to inquiries into failures of fundamental care in the United Kingdom (Francis, 2013) and Europe (van Achterberg et al, 2016), the Australian Royal Commission into Aged Care Quality and Safety (hereinto referred to as the Royal Commission) has revealed that the institutions and systems designed to provide care for vulnerable older people are often instead ‘cruel and harmful’; leaving the older person ‘isolated and powerless’ (Royal Commission into Aged Care Quality and Safety, 2019, p. 1, 2021).…”

Section: Introductionmentioning

confidence: 99%

An aged life has less value: A qualitative analysis of moral disengagement and care failures evident in Royal Commission oral testimony

Austen

Hutchinson

2021

Journal of Clinical Nursing

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Aims and objectives:To identify common themes about care failures in residential aged care as described from the perspectives of older people and their families in transcripts from hearings and submission to the Australian Royal Commission. These failures are explored through the lens of moral disengagement. Background: Previous inquiries into care failures have highlighted widespread harm from inhumane care, caused by staff carelessness, indifference and callousness. In health care, limited consideration has been given to the moral engagement or disengagement of staff and the relationship of moral engagement with care failures. Method: Qualitative latent content analysis of 22 transcripts from the Royal Commission between March 2020-August 2020. Methods are reported using the SRQR.Results: This paper presents one theme, Dehumanisation of the care process: An aged life has less value, from a larger study. Care failures relating to morally disengaged staff were found to be widespread and influenced by the environments created by organisations. Conclusion:This study highlights the need for further research to identify indicators of moral disengagement among staff and explore strategies to reduce or prevent moral disengagement within organisations trusted with providing care to older people. Relevance to clinical practice:Caregiving is necessarily associated with, and shaped by, moral dimensions. The erosion or disengagement of these moral dimensions among care staff reveals important aspects of residential aged care's lived experience.Studying dynamics within aged care facilities can provide a useful analytic lens for illuminating ways that residents and their family or those close to them, experience or are impacted by moral dimensions and behaviours.

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“…The assumption is that older people are able to choose the care they wish to receive, have the funds to choose the optimum outcomes for themselves, are fully aware of what these choices include and have the capacity to change their mind if they are not happy with the choices that they have made (e.g. Henderson & Willis, 2020; Moberg, Blomqvist & Winblad, 2016). Yet, this assumption has been challenged with literature that has acknowledged that older people can be vulnerable when making choices as many may not be aware that they can make these choices or they may be unaware of the alternatives available to them (Dunér & Gustafsson, 2020; Henderson & Willis, 2020; Vamstad, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Henderson & Willis, 2020; Moberg, Blomqvist & Winblad, 2016). Yet, this assumption has been challenged with literature that has acknowledged that older people can be vulnerable when making choices as many may not be aware that they can make these choices or they may be unaware of the alternatives available to them (Dunér & Gustafsson, 2020; Henderson & Willis, 2020; Vamstad, 2016). As such, the degree of vulnerability experienced by aged care consumers can limit their capacity to practise choice making over their preferred care services.…”

Section: Introductionmentioning

confidence: 99%

The decision‐making processes and preferences of older Australians purchasing home support services: An explorative inquiry using a “think‐aloud” technique

Rahja

Laver

Phillipson

et al. 2021

Aust J Social Issues

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Consumer-directed care (CDC) programmes, in principle, provide consumers with choices around who provides care services to them, what services and when. However, literature around consumer behaviour of older adults, especially concerning the factors that may support home care choices, is sparse. The purpose of this study was to understand the decision-making processes and spending preferences of communitydwelling seniors assessed eligible for CDC home care services. We completed an explorative inquiry using a "think-aloud" technique with eligible consumers in South Australia. The inquiry had two components. First, consumers used imitation money to simulate the purchase of home care supports while talking out loud their decision-making processes. Then, semistructured interviews were completed to identify underlying thoughts that informed the decisions made and spending preferences. Fifteen consumers, mean age 82 years (range 70-94), participated. The most frequently prioritised choice was domestic assistance. However, choices were made based on a perceived | 373 RAHJA et Al.

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Chapter Twelve: The Marketisation of Aged Care: The Impact of Aged Care Reform in Australia

Cited by 14 publications

References 27 publications

Co-designing a methodology for workforce development during the personalisation of allied health service funding for people with disability in Australia

Co-designing a methodology for workforce development during the personalisation of allied health service funding for people with disability in Australia

An aged life has less value: A qualitative analysis of moral disengagement and care failures evident in Royal Commission oral testimony

The decision‐making processes and preferences of older Australians purchasing home support services: An explorative inquiry using a “think‐aloud” technique

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