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Gibson D, Isbel S. Reform and reverberation: Australian aged care policy changes and the unintended consequences for allied health. Aust Occup Ther J 2024; 71:392-407. [PMID: 38714528 DOI: 10.1111/1440-1630.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 05/10/2024]
Abstract
INTRODUCTION Allied health has a valuable role in providing services to people living in residential aged care. The recent Royal Commission into Aged Care Quality and Safety included several important recommendations relating to the nursing, personal care, and allied health workforce and the care that they provide. The purpose of this paper is to review these recommendations and the Australian Government's policy responses and explore the emerging changes in allied health service provision in residential aged care. METHODS Data from the four available Quarterly Financial Reports from the 2022-2023 financial year were extracted and analysed in relation to staff costs and time per person per day across personal care, nursing, and allied health workers. Supplementary data sources including the 2020 Aged Care Workforce Census were accessed to provide contextual data relating to individual allied health professions, including occupational therapy. RESULTS The analysis shows a modest increase in median registered nurse minutes per person per day, and cost per person per day, from the first to second quarter, and again in the third and fourth. By contrast, median time and cost for allied health declined. From 5.6 minutes per person per day in the first quarter, reported allied health minutes fell to 4.6 minutes per person per day in the second quarter, an 18% decrease, and by the fourth quarter was 4.3 minutes per person per day. This is just over half the Australian average of 8 minutes reported to the RCACQS in 2019. CONCLUSION Under recent residential aged care reforms, aged care providers have regulatory incentives to concentrate their financial resources on meeting the mandated care hours for registered nurses, enrolled nurses, personal care workers, and assistants in nursing. These same reforms do not mandate minutes of allied health services. Although providers of residential aged care in Australia continue to employ and value allied health, we argue that mandating care minutes for personal and nursing care without mandating the provision of allied health creates a perverse incentive whereby access to allied health services is unintentionally reduced.
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Affiliation(s)
- Diane Gibson
- Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australia
| | - Stephen Isbel
- Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australia
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Mitterfellner R, D'Cunha NM, Isbel S. Occupation-Based Interventions to Improve Occupational Performance Among Older Adults Living in Long-Term Care: A Systematic Review. Am J Occup Ther 2024; 78:7801205140. [PMID: 38231082 DOI: 10.5014/ajot.2024.050441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
IMPORTANCE Evidence for the positive effects of occupation-based interventions on occupational performance is increasing; however, little is known about the impacts of occupation-based interventions on older adults living in long-term care. OBJECTIVE To consolidate the evidence on the effectiveness of occupation-based interventions for improving occupational performance among older adults living in long-term care. DATA SOURCES MEDLINE, CINAHL, PsycINFO, SCOPUS, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from journal-database inception to February 2023. STUDY SELECTION AND DATA COLLECTION This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles were peer-reviewed studies published in English that evaluated occupation-based interventions for older adults living in long-term care and used validated tools to measure occupational performance. FINDINGS Seventeen articles, with 2,974 participants, were identified. The reviewed studies included 6 Level 1b randomized controlled trials, 5 Level 2b studies of various study designs, and 5 Level 3b studies with quasi-experimental designs. Across studies, heterogeneous measures were used to assess occupational performance. All studies implemented client-centered, occupation-based interventions designed and/or delivered by occupational therapists. Interventions were tailored to residents' goals, interests, or abilities to improve occupational performance and participation, and inconsistent effects were reported. CONCLUSIONS AND RELEVANCE Moderate evidence supports the use of occupation-based interventions tailored to individual residents and incorporation of physical activities for improving the occupational performance of older adults living in long-term care. Currently, evidence for care partner involvement and multilevel occupation-based interventions is limited. Plain-Language Summary: This study adds to the evidence base indicating that occupation-based interventions have the potential to promote the occupational performance of older adults living in long-term care. High-quality randomized controlled trials with longer term follow-up and assessment of clinically meaningful outcomes are critical for developing the evidence base in this practice setting.
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Affiliation(s)
- Rachael Mitterfellner
- Rachael Mitterfellner, MOT, BMedSc, is Occupational Therapist, Canberra Health Services, and Professional Associate, Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia. At the time of this research, Mitterfellner was Postgraduate Research Student, School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Nathan M D'Cunha
- Nathan M. D'Cunha, PhD(Health), BHumNutr(Hons), is Assistant Professor, Human Nutrition, School of Exercise and Rehabilitation Sciences, Faculty of Health, and Theme Lead (Dementia and Cognition), Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Stephen Isbel
- Stephen Isbel, HScD, MOT, MHA, BAppSc(OT), GCTE, is Professor, Occupational Therapy, School of Exercise and Rehabilitation Sciences, Faculty of Health, and Theme Lead (Innovative Care Models), Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia;
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Meulenbroeks I, Seaman K, Raban MZ, Wabe N, Westbrook J. Just visiting: A qualitative study of Australian allied health professionals' experiences working in residential aged care facilities during the COVID-19 pandemic. Australas J Ageing 2023; 42:690-697. [PMID: 37321838 PMCID: PMC10946948 DOI: 10.1111/ajag.13217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/06/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Internationally, the COVID-19 pandemic has negatively impacted health professionals' experiences of delivering effective care. The experiences of health professionals are important: poor experience has been associated with poorer patient outcomes and high staff turnover. This study aimed to narratively explore the impact of the COVID-19 pandemic on the experience of delivering allied health (AH) care in Australian residential aged care (RAC). METHODS Semistructured interviews were conducted in February-May 2022 with AH professionals who had experience working in RAC during the pandemic. Interviews were audio-recorded, transcribed verbatim and thematically analysed in NVivo 20. Twenty-five per cent of interview transcripts were independently analysed by three researchers to create a coding structure. RESULTS Three themes were identified from interviews with 15 AH professionals to describe experiences delivering care pre-COVID-19, during COVID-19, and perceptions of care delivery in future. Prepandemic AH in RAC was believed to be under-resourced, delivering low-quality and reactive care. During the pandemic, pauses in, and the slow resumption of, AH services exacerbated professionals' feelings of being undervalued in resident care and in the workforce. Participants were optimistic about the impact AH could have in RAC in future if practice was embedded, multidisciplinary and funded appropriately. CONCLUSIONS AH professionals' experiences of delivering care in RAC are often poor, regardless of the pandemic. Further research on multidisciplinary practice and health professional experience in RAC is needed.
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Affiliation(s)
- Isabelle Meulenbroeks
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Karla Seaman
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Magdalena Z. Raban
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Nasir Wabe
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Johanna Westbrook
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
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Falvey JR, Hade EM, Friedman S, Deng R, Jabbour J, Stone RI, Travers JL. Severe neighborhood deprivation and nursing home staffing in the United States. J Am Geriatr Soc 2023; 71:711-719. [PMID: 36929467 PMCID: PMC10023834 DOI: 10.1111/jgs.17990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low nursing home staffing in the United States is a growing safety concern. Socioeconomic deprivation in the local areas surrounding a nursing home may be a barrier to improving staffing rates but has been poorly studied. Thus, the objective of this paper was to assess the relationship between neighborhood deprivation and nursing home staffing in the United States. METHODS This cross-sectional study used 2018 daily payroll-based staffing records and address data for 12,609 nursing homes in the United States linked with resident assessment data. Our primary exposure of interest was severe economic deprivation at the census block group (neighborhood) level, defined as an area deprivation index score ≥85/100. The primary outcome was hours worked per resident-day among nursing home employees providing direct resident care. Marginal linear regression models and generalized estimating equations with robust sandwich-type standard errors were used to estimate associations between severe neighborhood deprivation and staffing rates. RESULTS Compared to less deprived neighborhoods, unadjusted staffing rates in facilities located within severely deprived neighborhoods were 38% lower for physical and occupational therapists, 30% lower for registered nurses (RNs), and 5% lower for certified nursing assistants. No disparities in licensed practical nurse (LPN) staffing were observed. In models with state-level and rurality fixed effects and clustered on the county, a similar pattern of disparities was observed. Specifically, RN staffing per 100 resident-days was significantly lower in facilities located within severely deprived neighborhoods as compared to those in less deprived areas (mean difference: 5.6 fewer hours, 95% confidence interval [CI] 4.2-6.9). Disparities of lower magnitude were observed for other clinical disciplines except for LPNs. CONCLUSIONS Significant staffing disparities were observed within facilities located in severely deprived neighborhoods. Targeted interventions, including workforce recruitment and retention efforts, may be needed to improve staffing levels for nursing homes in deprived neighborhoods.
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Affiliation(s)
- Jason R. Falvey
- Department of Physical Therapy and Rehabilitation Science, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Erinn M. Hade
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Steven Friedman
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Rebecca Deng
- Department of Epidemiology, NYU School of Global Public Health, New York, NY
| | - Joelle Jabbour
- NYU Robert F. Wagner Graduate School of Public Service, New York, NY
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Meulenbroeks I, Seaman K, Raban MZ, Westbrook J. Allied health in residential aged care: Using routinely collected data to improve funding opportunities. Australas J Ageing 2023; 42:221-224. [PMID: 36069478 PMCID: PMC10946826 DOI: 10.1111/ajag.13136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Abstract
Consumers and providers have long been advocating for increased access to and delivery of allied health services in Australian residential aged care (RAC). There is significant evidence that allied health interventions are effective; however, there is limited evidence on the benefit of routine day-to-day allied health service delivery in RAC. This information is critical to effectively inform funders and policy advisors of the necessity of allied health in RAC. To improve arguments for future funding opportunities, providers, facilities and consumers need to partner together to use routinely collected, yet disparate, data, in electronic health and billing records, to improve data collection practices and evidence generation on allied health in aged care.
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Affiliation(s)
- Isabelle Meulenbroeks
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Karla Seaman
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Magdalena Z. Raban
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Johanna Westbrook
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
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Meulenbroeks I, Raban MZ, Seaman K, Westbrook J. Therapy-based allied health delivery in residential aged care, trends, factors, and outcomes: a systematic review. BMC Geriatr 2022; 22:712. [PMID: 36031624 PMCID: PMC9420184 DOI: 10.1186/s12877-022-03386-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Allied health professionals in residential aged care facilities (RACFs) make important contributions to the physical and mental wellbeing of residents. Yet to date, health services research in RACFs has focused almost exclusively on nursing disciplines. This review aims to synthesise the current evidence on allied health services in RACF; specifically, how therapy-based allied health is delivered, what factors impact the quantity delivered, and the impact of services on resident outcomes and care quality. Methods Empirical peer-reviewed and grey literature focusing on allied health service delivery in RACFs from the past decade was identified through systematic searches of four databases and over 200 targeted website searches. Information on how allied health delivered, factors impacting service delivery, and impact on resident outcomes were extracted. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT) and the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklist. Results Twenty-eight unique studies were included in this review; 26 peer-reviewed and two grey literature studies. Sixteen studies discussed occupational therapy and 15 discussed physiotherapy, less commonly studied professional groups included dieticians (n = 9), allied health assistants (n = 9), and social workers (n = 6). Thirteen studies were assigned a 100% quality rating. Levels of allied health service provision were generally low and varied. Five studies examined the association between system level factors and allied health service provision, and seven studies examined facility level factors and service provision. Higher levels of allied health provision or access to allied health services, specifically physiotherapy, occupational therapy, and nutrition, were associated with reduced falls with injury, improved care quality, activities of daily living scores, nutritional status, and meal satisfaction in five studies. Conclusion Evidence on how allied health is delivered in RACFs, and its impact on resident health outcomes, is lacking globally. While there are some indications of positive associations between allied health staffing and resident outcomes and experiences, health systems and researchers will need commitment to consistent allied health data collection and health services research funding in the future to accurately determine how allied health is delivered in RACFs and its impact on resident wellbeing. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03386-9.
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Shaw A, Cabrejo PT, Adamczyk A, Mulcahey MJ. Reducing Hospital Readmissions of Older Adults Pursuing Postacute Care at Skilled Nursing Facilities: A Scoping Review. Am J Occup Ther 2022; 76:23144. [PMID: 34997839 DOI: 10.5014/ajot.2022.049082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Unplanned hospital readmissions can profoundly affect older adults' quality of life and the financial status of skilled nursing facilities (SNFs). Although many clinical practices focus on reforming these issues, occupational therapy's involvement remains unclear. OBJECTIVE To explore clinical practices aimed at reducing hospital readmissions of older adults pursuing postacute care (PAC) at SNFs and describe how they align with occupational therapy's scope of practice. DATA SOURCES We searched CINAHL, Scopus, PubMed, and OTseeker for articles published from January 2011 to February 2020. Study Selection and Data Collection: We conducted a scoping review of peer-reviewed articles with functional outcomes of clinical practices reducing unplanned hospital readmissions of patients older than age 65 yr pursuing PAC services in SNFs. Trained reviewers completed the title and abstract screens, full-text reviews, and data extraction. FINDINGS Thirteen articles were included and focused on five areas: risk and medical disease management and follow-up, hospital-to-SNF transition, enhanced communication and care, function, and nutrition. Early coordination of care and early identification of patients' needs and risk of readmission were common features. All clinical practices aligned with occupational therapy domains and processes, but only 1 study specified occupational therapy as part of the research team. CONCLUSIONS AND RELEVANCE Comprehensive, multipronged clinical practices encompassing care coordination and early identification and management of acute conditions are critical in reducing preventable readmissions among older adults pursuing PAC services in SNFs. Further research is needed to support occupational therapy's value in preventing hospital readmissions of older adults in this setting. What This Article Adds: This scoping review maps the presence of occupational therapy's domains and processes in the clinical practices that reduce hospital readmissions of older adults pursuing PAC services in SNFs. Findings provide occupational therapy practitioners with opportunities to assume roles beyond direct patient care, research, advocate, and publish more, thereby increasing their presence and adding value to occupational therapy interventions that reduce hospital readmissions.
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Affiliation(s)
- Antoinette Shaw
- Antoinette Shaw, OTD, OTR/L, is Director of Rehabilitation Services, Genesis Healthcare Corporation, Catonsville, MD;
| | - Pamela Talero Cabrejo
- Pamela Talero Cabrejo, OTD, OTR/L, is Adjunct Assistant Professor, Post-Professional Occupational Therapy Program, Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
| | - Abby Adamczyk
- Abby Adamczyk, MLIS, AHIP, is Professional Librarian, Thomas Jefferson University, Philadelphia, PA
| | - M J Mulcahey
- MJ Mulcahey, PhD, OTR/L, is Professor of Occupational Therapy, Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
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The effects of early post-discharge rehabilitation services on care-needs level deterioration in older adults with functional impairment: A propensity score–matched study. Arch Phys Med Rehabil 2022; 103:1715-1722.e1. [DOI: 10.1016/j.apmr.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022]
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Peterson LJ, Bowblis JR, Jester DJ, Hyer K. The Relationship Between Staffing Levels and Consumer Complaints in Nursing Homes. J Aging Soc Policy 2021; 34:742-754. [PMID: 34396928 DOI: 10.1080/08959420.2021.1962173] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
While research tends to find an association of nurse staffing with quality in nursing homes, few studies examine complaints as a quality measure or account for ancillary staff. This study used federal nursing home complaint data to examine how key explanatory variables including nursing and ancillary staffing were associated with numbers of complaints and the likelihood of receiving a complaint. Results support that nursing home staffing is associated with quality. While direct care staffing was associated with fewer complaints, larger effects were found for social service and activities staffing. Increasing ancillary staffing may be a cost-effective way to reduce complaints.
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Affiliation(s)
- Lindsay J Peterson
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida
| | - John R Bowblis
- Department of Economics and Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
| | - Dylan J Jester
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida
| | - Kathryn Hyer
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida
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