Sufficient exercise for Australians living with dementia in residential aged care facilities is lacking: an exploration of policy incoherence

Brett, Lindsey; Stapley, Paul J.; Meedya, Shahla; Traynor, Victoria

doi:10.1111/1753-6405.12800

Cited by 6 publications

(7 citation statements)

References 15 publications

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“…The ACFI creates challenges for occupational therapists to sustainably contribute to this practice setting, by emphasising residents' dependence, restricting opportunities for residents' occupational performance and engagement, and directing therapists to practise under scope. It appears that other professions are experiencing similar challenges in their practice under the ACFI (Brett et al, 2018; Rayner et al, 2020). Physiotherapists, who are more skilled and knowledgeable in pain management, using massage and electrical modalities, have noted that the ACFI is not consistent with the evidence and limits physiotherapists from making clinically based, client centred decisions (Brett et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…It appears that other professions are experiencing similar challenges in their practice under the ACFI (Brett et al, 2018; Rayner et al, 2020). Physiotherapists, who are more skilled and knowledgeable in pain management, using massage and electrical modalities, have noted that the ACFI is not consistent with the evidence and limits physiotherapists from making clinically based, client centred decisions (Brett et al, 2018). Additionally, nurses have identified that the ACFI inhibits their ability to provide high‐quality, client‐centred care (Rayner et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…The ACFI seems to be contributing to an unstable and insecure workforce in RACFs. There is evidence of high staff turnover within multiple health professions in this practice setting, including occupational therapy (Brett et al, 2018; Occupational Therapy Australia, 2019; Rayner et al, 2020). One way to understand this poor retention is using the concept of moral distress.…”

Section: Discussionmentioning

confidence: 99%

“…The ACFI also dictates the scope of practice for health professionals providing services within RACFs. For occupational therapists, this limits practice to chronic pain management, and only if modalities such as therapeutic massage and electrotherapy are used (Brett et al, 2018; Occupational Therapy Australia, 2019). Occupational therapists have expressed that the ACFI constrains their practice by not recognising their unique expertise and contribution to health and wellbeing (Hubbard et al, 2018; Occupational Therapy Australia, 2019).…”

Section: Introductionmentioning

confidence: 99%

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Understanding occupational therapy practice in residential aged care facilities under the Aged Care Funding Instrument: A qualitative study

Calderone

Bissett

Molineux

2022

Aus Occup Therapy J

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Introduction Australian occupational therapy practice in residential aged care facilities has been largely funded using the Aged Care Funding Instrument since March 2008. Literature indicates that the funding model constrains occupational therapy practice, impacting on therapists' and residents' experiences. In preparation for the implementation of the new funding model, the Australian National Aged Care Classification, it is timely to understand current practice. Therefore, the aim of this study was to explore occupational therapy practice in residential aged care facilities under the Aged Care Funding Instrument. The objectives were (1) to understand occupational therapists' experiences of working in residential aged care facilities under the Aged Care Funding Instrument; and (2) to explore occupational therapists' perceptions of how the Aged Care Funding Instrument influences residents' occupational performance and engagement. Methods A phenomenological research design was employed to understand therapists' perspectives. Data were collected from seven occupational therapists using a demographic form and a semi‐structured interview. Data were analysed using a modified Colaizzi's descriptive phenomenological data analysis. Ethics approval was obtained. Findings Two themes emerged from the study's findings: a restrictive practice context that disables residents; and a restrictive practice context that inhibits occupational therapists. The first theme describes how the Aged Care Funding Instrument constrains practice and incentivises the disabling of residents. The second theme describes the challenges faced by occupational therapists throughout their journey of employment under the funding model. Conclusion Occupational therapists perceived that the Aged Care Funding Instrument restricts occupational therapy practice and prevents residents from living occupationally rich lives. With the introduction of the Australian National Aged Care Classification in late 2022, it is crucial that national associations and employers advocate to policymakers to ensure future practice reflects the profession's unique knowledge and skills to optimise the health and wellbeing of residents.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Understanding occupational therapy practice in residential aged care facilities under the Aged Care Funding Instrument: A qualitative study

Calderone

Bissett

Molineux

2022

Aus Occup Therapy J

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“…An Australian study provided very broad categories (e.g., pain management, non-pain management and paperwork) [30], whilst an American study reported specific modalities of pressure ulcer management [31]. The focus on pain management services in the Australian study is likely due to the current aged care funding model which only funds physiotherapists to provide massage and electrotherapy for pain management [30], despite the lack of endorsement of these strategies by current evidence-based recommendations for chronic pain [36]. The American study focused on pressure ulcer management [31], which is a service predominately practiced by physiotherapists in the USA only [37].…”

Section: Discussionmentioning

confidence: 99%

The use of physiotherapy in nursing homes internationally: A systematic review

et al. 2019

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Background Physiotherapy can improve functional ability, prevent falls and reduce pain for older adults in nursing homes. However, there are no legislations or guidelines that specify the parameters of physiotherapy required in nursing homes. With the increasing healthcare demands of ageing populations worldwide, it is important to understand the current use of physiotherapy services to ensure they are both evidence-based and promote equity. Objectives (1) When and how are physiotherapy services used by older adults living in nursing homes? (2) What are the factors associated with use of physiotherapy services in nursing homes? (3) How are physiotherapy services in nursing homes documented and monitored? Methods Several databases and grey literature (including MEDLINE, PubMed, Pedro and EMBASE) were searched following PRISMA guidelines in March 2018. Searches were limited to English language publications from 1997. Assessment for inclusion, data extraction and quality assessment were completed by two investigators independently using standardised forms. Studies were included if they considered any type of physiotherapy service that involved a qualified physiotherapist (such as exercise, massage and staff education) with older adults (aged 60 years and older) that were primarily permanent residents of a nursing home. Data extracted included proportion of clients that used physiotherapy services, type, frequency and duration of physiotherapy services, and factors associated with physiotherapy service use. Results Eleven studies were included. Between 10% and 67% of nursing home clients used physiotherapy services. Factors associated with greater use of physiotherapy services included larger size facilities, and if clients had a physical impairment and mild or no cognitive impairment. Types of physiotherapy services reported were pain management and pressure ulcer management. Conclusions Physiotherapy service use in nursing homes varied widely. The development of physiotherapy benchmarks and quality standards are needed to support older adults in nursing homes. PROSPERO registration number : CRD42018082460.

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Reforming allied health service provision in residential aged care to improve the rehabilitation reach: a feasibility study

Brusco,

Ekegren,

Rawson

et al. 2024

Aust. Health Rev.

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Objective My Therapy is an allied health guided, co-designed rehabilitation self-management program for residents of aged care facilities. This study aimed to determine the feasibility of implementing My Therapy in a residential aged care setting. Methods This observational study was conducted on a 30-bed wing, within a 90-bed metropolitan residential aged care facility, attached to a public health service, in Victoria, Australia. Staff and resident data were collected prospectively over 6 weeks (staff focus groups, patient surveys, and audits) to evaluate the feasibility domains of acceptability, reach and demand, practicality, integration, limited efficacy testing and adaptations. Results Twenty-six residents and five allied health staff (physiotherapy and occupational therapy) participated. My Therapy was acceptable to residents (survey) and staff (focus groups). Via initial My Therapy discussions between the resident and the therapists, to determine goals and resident preferences, My Therapy reached 26 residents (n = 26/26, 100% program reach), with 15 residents subsequently receiving a rehabilitation program (n = 15/26, 58% program demand). The remaining 11 residents did not participate due to resident preference or safety issues (n = 11/26, 42%). Collecting physical function outcome measures for limited efficacy testing was practical, and the cost of My Therapy was AUD$6 per resident per day, suggesting financial integration may be possible. Several adaptations were required, due to limited allied health staff, complex resident goal setting and program co-design. Conclusion My Therapy has the potential to improve the rehabilitation reach of allied health services in residential aged care. While introducing this low-cost intervention is feasible, adaptations were required for successful implementation.

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Sufficient exercise for Australians living with dementia in residential aged care facilities is lacking: an exploration of policy incoherence

Cited by 6 publications

References 15 publications

Understanding occupational therapy practice in residential aged care facilities under the Aged Care Funding Instrument: A qualitative study

Understanding occupational therapy practice in residential aged care facilities under the Aged Care Funding Instrument: A qualitative study

The use of physiotherapy in nursing homes internationally: A systematic review

Reforming allied health service provision in residential aged care to improve the rehabilitation reach: a feasibility study

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