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Pathways to a new future

Aged care facilities should provide quality clinical placements to nursing students, writes Dr Andrew Robinson.

Australia faces multiple challenges in providing high quality care in residential aged care facilities. The resident population is rapidly moving to higher levels of dependency with an associated increase in care needs. This is evident in data which highlights that, between 1999 and 2006, the number of elderly people admitted to facilities requiring the highest level of care increased from around 12 per cent to over 20 per cent. Of this group 50 per cent will die within 12 months.

This trend is set to escalate as the population ages and a reliance on community care for all but the most dependant people becomes the norm. Given estimates that around 80 per cent of residents in high care have some form of cognitive impairment, it is arguable that in the future high care facilities will have a growing role in providing sub-acute end of life dementia care.

Worryingly, the increasing demand for skilled care has been accompanied by the progressive deskilling of the aged care workforce. The 2008 National Institute of Labour Studies report notes that between 2003 and 2007 the number of registered nurses employed in the sector declined from 21.4 per cent to 18.6 per cent. The report makes it clear the proportion of unregulated workers providing care to the elderly has increased from 56.5 per cent to 64.1 per cent in the same period. This trend of increasing dependency combined with a decreasing skill set positions the sector in the path of a perfect storm. In these circumstances, how will we ensure that elderly residents with multiple co-morbidities, most of whom will have some form of dementia, receive appropriately skilled care?

This scenario dictates a rethink of the future for ageing. We must adopt a planned and strategic approach to building the capacity of facilities for a new future in which increasingly dependant and infirm residents receive care from a new generation of highly skilled practitioners.

The ongoing viability of facilities depends on a high quality sustainable workforce and talent pipeline. To position aged care at the cutting edge of health and social care service provision, a new generation of health professionals must be attracted. Creating positive learning experiences for students across all disciplines is central to this aim because the evidence indicates the clinical placement itself is seminal in determining students employment choices.

My team at the University of Tasmania has achieved great success in pinpointing what makes a quality clinical placement in an aged care facility, and developing the best possible placements. Nine out of ten of the students involved in our program say they would consider future employment in the sector. Together with a systematic review of the aged care clinical placement literature, this research informed the development of an evidence based/best practice model (EBBPM) of quality clinical placements in aged care. The EBBPM provides a clear framework for developing the necessary structures and processes to provide students with a positive learning experience in the sector. Our modelling suggests that if the EBBPM was introduced we could recruit an additional 2500 nurses Australia-wide, providing a vital boost to the sector.

Our research also revealed that, in general, facilities struggle to provide sa positive placement experience, due to a mix of individual, team and organisational capability issues. While we have had great success in working with staff on the floor to build capacity to provide quality clinical placements, we find that aged care organisations often struggle to effectively support the new arrangements. Despite the best of intentions, a history of entrenched hierarchy, operational silos and the stress of operating in an environment of ever impending crisis, limits the capacity for an effective response.

To move the aged care sector away from living on an emotional edge, a financial edge and a staffing edge we need to rethink our notion of aged care as somehow isolated from mainstream health care services. Providing quality care to residents with a rapidly changing demographic, together with a need to recruit, train and support skilled staff, means we need to adopt a different paradigm from that of the traditional nursing home, which had a primary focus on the provision of domestic care. We have to account for the changes in operational conditions outlined above as well as acknowledge that facilities have ever increasing responsibilities in the education of health care professionals and aged care workers.

To support the transition of facilities into the 21st century we need to develop formalised partnerships between universities and aged care organisations. Australia needs to build a national network of teaching nursing homes. Like teaching hospitals, teaching nursing homes will provide an infrastructure to support a robust and much needed program of research into aged care and importantly, give us an internationally significant edge in a growth sector. This is critical to developing our knowledge and practices in ways that appropriately meet the care demands of the future.

Dr Andrew Robinson is professor of aged care nursing, school of nursing and midwifery at the University of Tasmania. Referenced version of article available by emailing [email protected]

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