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

Abstract

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.

Role of occupational therapy in person‐centred dementia care: Exploring family member and clinician perceptions

“…approaches, suggesting that existing occupational therapy expertise may be underutilised to the detriment of residents. 3,24 A better understanding of the occupational therapy role in person-centred dementia residential facilities could inform ongoing development and maximise the profession's potential impact on residents.…”

“…Occupational therapists have reported challenges to implementing person‐centred dementia care in residential aged care facilities 24 . Aged care funding arrangements designed to provide more funding for residents with greater disability discourage interventions which maximise occupational opportunities for residents 24 . Australian studies by Rahja et al 3 .…”

“…2,23 Occupational therapists have reported challenges to implementing person-centred dementia care in residential aged care facilities. 24 Aged care funding arrangements designed to provide more funding for residents with greater disability discourage interventions which maximise occupational opportunities for residents. 24 Australian studies by Rahja et al 3 and Calderone et al 24 confirm occupational therapists in residential aged care are prompted to focus on assessing or identifying deficits rather than promoting occupation through intervention and can feel pressured to employ non-evidence-based interventions such as pain massage and fall prevention programs.…”

“…24 Aged care funding arrangements designed to provide more funding for residents with greater disability discourage interventions which maximise occupational opportunities for residents. 24 Australian studies by Rahja et al 3 and Calderone et al 24 confirm occupational therapists in residential aged care are prompted to focus on assessing or identifying deficits rather than promoting occupation through intervention and can feel pressured to employ non-evidence-based interventions such as pain massage and fall prevention programs. Preconceived expectations of passivity and frailty for residents by staff, limited resource availability and inadequate staff training are barriers 11 to person-centred care in residential aged care facilities.…”

A profile of practice: The occupational therapy process in community aged care in Australia

“…Recommendations for practice change and methods for practice improvement can be made based on insights gained from Key Points for Occupational Therapy • Client-centred practice remains central despite limiters of funding and time • The occupational therapy process aligns with aged care reforms • Scope of occupational therapy practice could include more preventative approaches exploring current occupational therapy practices. For example, a recent Australian study qualitatively explored occupational therapy practice in residential aged care, finding that occupational therapists were restricted by the funding model used (Calderone et al, 2022). Another older study surveyed occupational therapists about their work with children in Australia and Canada (Brown et al, 2007;Rodger et al, 2005) and found that the range of theoretical models used was largely incongruent with their chosen assessments and interventions (Rodger et al, 2005).…”