The expert guide to better care

Last year, the Older Persons Advocacy Network (OPAN) recorded 44,400 cases in which older Australians sought out the organisation’s help with resolving their aged care issues, either through information, advocacy or support. That number represents a 20 per cent increase on the previous year.

In the period between July and December 2024, 44 per cent of the Network’s advocacy cases were related to home care – nearly double the amount related to residential aged care (23 per cent).

In its mid-year report, OPAN highlighted communication standards and access to home care packages as the two most pressing issues for older Australians.

The report clearly showed that the gap between policy reform and public understanding was widening, particularly when it comes to the Albanese government’s new Support at Home plan.

Chief executive officer Craig Gear OAM says he has seen the demand for OPAN’s free and independent support for older people using government-funded aged care services grow year on year.

“Although there are pockets of high quality care out there it’s not propagated, celebrated or permeating the experience of every older person across the country,” he said.

“We haven’t had a system that has got the workforce funded, paid, valued, respected, or trained enough to be able to deliver high quality care.

“We didn’t have the funding system right, we didn’t have the Quality Standards right, but fundamentally sitting under all this, we didn’t have the human rights of older people at the forefront of everything we were doing in aged care.”

The new Aged Care Act, being rolled out November 1, is in response to these very issues.

What do older people really want?

Put simply, older Australians want their care to be a relationship.

The Aged Care Quality and Safety Commission’s Strengthened Quality Standards are due to come into effect alongside the new Aged Care Act on November 1.

The Standards centre on the dignity and respect of each individual that chooses to engage aged care services, highlighting crucial concepts of “individuality and diversity, independence, choice and control, culturally safe care and dignity of risk” as the foundation upon which the entire sector must be rebuilt.

“What I hear from older people is that they want providers to be ready for 1 November to start to deliver care that listens to them, and that respects their choice and autonomy to make their own decisions,” Mr Gear said.

“The opportunity of the new Age Care Act is reframing everything that we do through the lens of a statement of rights, to include the older person, with them in charge, supporting them to make their own decisions.”

The Statement of Rights lives in the small moments of daily care: a knock on the door to ask what time a resident might want to shower, allowing someone to have choice and control over the food they eat or who can come to visit them and when.

“Rosemary, who lives in residential aged care, said to me: ‘this Statement of Rights is really a bit of a sword and a shield.’ It’s a sword to say [to providers] get on with it, and it’s a shield to protect her as well for when things go wrong,” Mr Gear said.

“People have been telling me they want connection and they want to be listened to, that’s the statement of rights.”

Better design, better care

When considering what makes good aged care design, architect Nick Seemann has only one question; is the environment making this person’s life and the provision of care easier or is it getting in the way?

As co-author of the National Aged Care Design Principles and Guidelines, Mr Seemann would like to see Australian aged care providers remove some of the clutter, noise and obstacles from within their facility, and notice how these simple adjustments to the environment makes their work easier.

“People often think the environment is a big thing that requires lots of money to change, when what staff do actually recreates an environment every day,” he said.

This can be as simple as training staff to unlock the doors out to gardens, or finding ways to include residents in the preparation of a snack or meal.

“A cousin of my father’s, who moved into care at the end of his life, had a small step at the edge of his room that meant he never stepped out to the balcony, because the building got in the way,” Mr Seemann said.

“The move into care homes is often prompted by a physical or cognitive impairment. The physical environment either becomes a support or it turns the impairments into disabilities.”

The new Strengthened Quality Standard 4: The environment is closely aligned with the Principles and Guidelines, in that it focuses on care environments that are not just safe, clean and comfortable, but enabling.

The Standard outlines the requirement for the environment to help residents to feel safe and comfortable, to be welcoming and easy to understand. The Principles and Guidelines show providers how to do that.

“In terms of a provider thinking through what that means, a lot of it does come down to how staff use the existing environment. When we're looking at Quality Standards, the building itself is one thing, but how the staff actually work with the building is a key way of dealing with the new Standard 4,” Mr Seemann said.

“It’s also important that staff have places that they can retreat to when they’re on a break, and dedicated spaces where they can do administrative work, so that administrative work is not something which is the centre of the home.”

Dementia-specific care

Dementia Training Australia (DTA) executive director Dr Isabelle Meyer said the best care is achieved at the intersection of training and the environment.

“There are really two profound things that we’re trying to do that will underpin what we believe is a new future for aged care in Australia. And that is a focus on training to enable the best care to be delivered and a focus of an environment in which that care can be delivered,” she said.

“A lot of our residential aged care facilities in the past have been built largely around a hospital or dormitory model and that’s no longer what people should be expecting.

“Older people have the right to expect that wherever they live, their environment will feel like a home and will enable them to pursue the activities that they’re interested in pursuing safely and that they will receive appropriate stimulation and support as and when they need it.”

DTA provides government-funded training and education on the care of people living with dementia. The consortium recently developed the National Dementia Education and Training Standards Framework, which has been endorsed by the World Health Organisation.

Access free design and environment resources here.

Into the great outdoors

Researchers from the University of Tasmania's (UTas) Wicking Dementia Research and Education Centre are quite literally thinking outside the box when it comes to dementia care.

The Venture Out Living Lab Nature Hubs are the product of a collaboration between UTas and local communities, aimed at promoting and observing the many benefits of dementia-friendly green spaces.

“One of the things that we’re hoping to look at is the role of nature in reducing stress,” co-lead of the nature-based dementia research group Dr Pauline Marsh said.

“We know that nature reduces stress in the general population and we also know that living with dementia can create a range of new stressors for people, both for the person living with dementia and for their care partner.

“When people are in a natural environment it can reduce the cognitive load and also support the use of implicit memory, or body memory, to enable people to participate in the space.”

The project now has six pilot sites in Tasmania, a mix of different types of green spaces including community gardens, bushland gardens and even private farmland.

To make the spaces more dementia-friendly the Venture Out team collaborates with community partners to make small but impactful changes. These might be additional seating, more shade, way-finder signage, and visual prompts for points of interest, such as when there’s something beautiful to smell, a plant that’s flowering at a particular time, or where a water bird might be nesting.

Dr Marsh explained that not only can being in nature have a calming effect for people living with dementia, but the added benefits of physical exercise and time in the sun can help to alleviate some of the sleep challenges that often accompany cognitive decline.

“Part of what we’re exploring is to see if being in nature can assist with maintaining a routine of being awake in the day and sleeping at night.”

A global study by Alzheimer’s Disease International (ADI) released in September last year, revealed that 80 per cent of the general public incorrectly believe that dementia is a normal part of ageing.

As awareness is crucial to early diagnosis and better patient outcomes, programs like Venture Out benefit the whole community, not just those with dementia.

“Nobody benefits from locking people away who might have some sort of communication or social challenges. If we’re in regular contact with people living with dementia, then an element of fear is removed, we become more comfortable with each other and it lessens the stigma around the disease.”

Is virtual nursing the future of aged care?

A new age of digital healthcare is upon us, meaning the incorporation of technological solutions into daily workflow has become a non-negotiable.

But while a scribe powered by artificial intelligence may save snippets of time for medical practitioners, and a small purple robot may be able to provide some companionship to older people experiencing social isolation, new tech is yet to really make a dent in one of the sector’s biggest issues – workforce shortages.

That was until the Department of Health, Disability and Ageing announced its $1.66 million Virtual Nursing (VN) in Aged Care project.

The project will recruit 30 aged care facilities over the next 18 months to test whether existing telehealth models can be adapted to lessen the burden of care minutes and 24/7 registered nurse (RN) requirements on providers. 

Health service provider Amplar Health has been recruited to provide the virtual nursing service, and La Trobe University’s Australian Institute for Primary Care & Ageing (AIPCA) and John Richards Centre for Rural Ageing Research will evaluate the project.

Senate estimates from late last year showed a shortage of almost 1500 RNs working in aged care, however, Amplar Health chief executive Rob Read chooses to see the sector’s workforce woes as an opportunity rather than a problem.

“Curiosity is vital, we have to question how we can do things differently, leveraging technology or AI,” he said.

“The population is not only ageing but dealing with more chronic diseases.

“In fact, the length of time that an average Australian lives unhealthily, or with a poor quality of life due to health complications, is extending.

“We need to be really thoughtful about how we do things early on, with technology that empowers patients.”

Registered nurses that are a part of the trial will be assigned to a provider virtually, based on their skills and the facility’s needs, building a relationship with both residents and staff over time.

This hybrid workforce model, if successful, will open the door for the introduction of virtual GPs, geriatricians and palliative care specialists in support of staff on the ground.

“As a country, if we’re not embracing how face-to-face care can be augmented and supported with virtual and digital care, then I think we’re going to run into some pretty significant workforce constraints,” Mr Read said.

“This is a big opportunity for us to think very differently about virtual care and how it interacts in core parts of the health system. And then we will have to start thinking about how we train the workforce of the future to work hand in glove with digital tools, AI and virtual care.”

Academics from La Trobe University will assess the project to determine the real impact of the VN trial.

They hypothesise that providing a virtual RN service to aged care providers will contribute to a reduction in ED transfers and hospital admissions, boost staff confidence, and promote more person-centred care.

Dr Samantha Clune, a senior research fellow with AIPCA, told Aged Care Insite that the VN project is a direct response by the government to the Royal Commission.

“Within the recommendations, there was an identification that the presence of and contribution of expertise by a registered nurse within aged care contributes to better overall outcomes of care for residents,” she said.

“Additionally, by having a registered nurse in an aged care facility, there is a transfer of clinical acumen and expertise to the other staff, so decisions are made at a more critical level. And there is a much broader repertoire of experience and knowledge that is drawn from by the staff within those facilities when they make care decisions.”

In terms of virtual support within aged care more broadly, the literature review conducted by AIPCA included clear evidence that staff who have a sense of support have a much higher level of satisfaction and confidence in their work.

Professor of aged care research and policy development Yvonne Wells adds that with the introduction of VN into a facility, the La Trobe team will be keeping a close eye on data points including hospital transfers and serious incident reports, as well as completing a comprehensive economic evaluation and consumer experience assessment.

“We’d really like to find out from the residents what it’s like to be involved in a virtual consultation, because that’s one of the gaps that we identified in the literature. There’s a fair bit about staff and what staff think, but very little about what residents and families think,” she said.

“We’ll be looking at some of the costs associated with providing the service in contrast with savings that might eventuate due to, for example, savings in staffing, in ED admissions or medications.

“Some of the homes that we’ve spoken to are already considering that one of the main benefits of the project will be that they won’t actually have to have their own existing staff on call overnight because there’ll be an allocated service to provide that assistance.

“This is a really exciting opportunity and we’re really pleased that we’re involved in the evaluation of it.”

Food first, person-centred

The Royal Commission into Aged Care Quality and Safety highlighted the widespread substandard quality, quantity, and nutritional value of the food available to older people as part of their care.

A representative study of 60 Australian residential aged care services was cited, which showed a staggering “68 per cent of residents were malnourished or at risk of malnutrition” in 2017.

The Royal Commission pointed to inadequate funding, staff training, and poor regulatory standards as the key factors behind the sector’s nutritional crisis.

Since then we’ve seen the establishment of the Food, Nutrition and Dining Unit, providers are using texture modified and moulded foods as a remedy for dignified dining, reduced fragility and overall enhanced nutritional status. We’ve also seen Australian food legend Maggie Beer emerge as the face of a new generation of aged care kitchens.

Now, Strengthened Quality Standard 6: Food and nutrition endeavours to uphold the fundamental human right that is access to nutritionally adequate food for every single older person in the country.

Dietitian and Eat Well Nutrition Service managing director Emma Rippon has specialised in aged care dietetic services for over twenty years. She and her team of dietitians focus on a ‘food first’ approach when helping older people to minimise the clinical impacts of poor nutrition.

“Food first means using real-food strategies to combat nutritional concerns and weight loss before we consider the use of commercial nutrition supplements,” she explains.

“Residents enjoy and deserve tasty and nutritious food, this enhances their quality of life and helps to maintain their enjoyment of meals.”

Standard 6 dictates four food related outcomes providers must achieve from November 1:

• Outcome 6.1: Partnering with individuals on food and drinks
• Outcome 6.2: Assessment of nutritional needs and preferences
• Outcome 6.3: Provision of food and drinks
• Outcome 6.4: Dining experience.

Ms Rippon’s message to providers is one of connection, communication and collaboration.

“The opportunity of these new Strengthened Quality Standards is to bring everyone together to enhance food and nutrition,” she said.

“So you’ve got a residential manager, a clinical manager, a head chef and lifestyle officers who can all contribute to the dining experience. A dietitian is able to engage these key stakeholders and contribute in a meaningful way to the collaboration needed for food and nutrition compliance.”

Improving medication safety

Like food, medication use in aged care came under intense scrutiny during the Royal Commission.

In particular, the sector came under fire for the inappropriate and over-use of psychotropic medications as a form of chemical restraint rather than for clinical indication.

As more and more older Australians living with chronic illness, co-morbidities and increasingly complex needs enter aged care, it is crucial for providers to adopt an integrated, multidisciplinary approach to medicine safety.

“One of the big challenges in aged care is that often the health care professionals you need are not always in the same room at the same time,” Monash University’s Centre for Medicine Use and Safety (CMUS) research fellow Dr Amanda Cross said.

“But having structures in place to ensure that you’ve got that multidisciplinary input, both at a resident level, ensuring that case conferences are occurring with the right people, and at a systems level, is really important.”

Dr Cross recently led a national audit of Medication Advisory Committees (MACs) in aged care facilities to examine their structure and function.

“Anecdotally, MACs are sometimes seen as just a tick box,” she explained.

“We conducted a survey, which was based on the guiding principles for medication management in residential aged care and the audit tool that was released with that, to assess how MACs are structured and functioning.

“A key part of the survey was asking whether the committees were multidisciplinary. Did they have representation from nursing, pharmacy, and prescribing? And only about half of respondents did.

“In terms of function, only 28 per cent of the MACs that we audited said that they performed all the functions related to quality improvement.”

MACs will be the key for providers hoping to meet Strengthened Quality Standard 5.1, which centres on clinical governance, but Dr Cross said they are a missed opportunity for driving the quality use of medicines in aged care.

Residential medication management reviews have too been historically underutilised, however, new Quality Standard 5.3 in particular highlights the importance of regular medication reviews, and also the key instances in which they should happen.

“Reviews should happen when a person has entered into a residential care home; when they’ve gone through a transition of care, maybe discharge back from hospital; if there's a new medication; if there’s been a change in medical status; or if they’re on high risk medications or polypharmacy. It’s really important to ensure that they’re happening at the right time and in the right way,” Dr Cross said.

“Sometimes high-risk medications are unavoidable, but a key part of minimising medication-related harm is having the right processes in place, so making sure staff understand what a high-risk medication is and what they can do to help minimise the errors when dealing with them.”

How to train resilience

As the sector faces ongoing workforce shortages, sweeping reform and increasingly complex expectations, resilience has become one of the most valuable attributes of an aged care worker.

Which is why it’s good to know that research shows that resilience is a skill that can be taught, practiced and improved, just like any other.

Professor of human resource management Denise Jepsen has worked with the Macquarie Business School to do just that. Her focus is on using the skills of resilience and recovery to create a capable, sustainable and happy aged care workforce, which, in turn, leads to better employee retention rates and improved care for older Australians.

“When we talk about the aged care workforce often we’re talking about frontline workers, but I also want to highlight management stresses,” Professor Jepsen said.

“Our middle and senior management are under enormous stress as well as our frontline workers, and that includes things like the regulatory environment and the legislative changes that we’re seeing now.”

Professor Jepsen broadly defines resilience as the ability to ‘bounce back’ from stressful experiences including hardship and serious traumatic experiences, she said there are two key ways that resilience can be experienced:

• Robust resilience is where people experience no deterioration in functioning despite the experience of psychosocial risks.
• Bouncing back is what most people think of when they think about resilience; where we might experience a small and temporary reduction in functioning (e.g. sleep loss) but we quickly return to previous levels of good functioning.

In a 2024 study, residential aged care employees took part in workshops designed to teach skills of self-reflection, and how it can aid in creating a workplace culture in which resilience is deeply embedded, and it delivered some outstanding results

“In our interventions we not only taught supervisors and employees how to do self-reflection but we added self-reflection opportunities to the daily and weekly agendas and scheduled time for debriefs, so that practice becomes a ‘business as usual’ way of working,” Professor Jepsen said.

“The workshop [results] show statistically significant improvement in depression and anxiety levels. Three months after the workshops, those employees who engaged in the self-reflection practices showed significant improvement in their resilience and stress levels.

“We were really delighted with that, and there were further improvements in job satisfaction and organisational commitment.”

The benefits to scheduled self-reflection practices are not limited to the individual, however. The research shows that when staff are supported to work on their emotional regulation daily, the flow on effects are widespread.

“We also had good results at the organisational level. We looked at staff turnover and absenteeism data across 16 different villages with a wide variance in the type of village, metropolitan, rural and so on, and we saw a substantial reduction in employee turnover in villages that participated in the research compared with villages that did not,” Professor Jepsen said.

“These outcomes underscore the value of self-reflection as a resilience and stress management strategy in the aged care workforce, and demonstrate that appropriate tailored attention on key employee issues can make a substantial difference, for employees and the organisation and ultimately, enhance resident care.”

From evidence to action: Supporting quality palliative care in aged care

By Dr Raechel A Damarell

The Strengthened Quality Standards reflect a shift towards more person-centred, accountable, and evidence-based aged care in Australia. 

A notable addition is Outcome 5.7: Palliative care and end-of-life care, which introduces new requirements for providers. These include recognising when residents are approaching the end of life, responding with timely and appropriate care, involving families in decisions, managing symptoms effectively, and ensuring that care remains respectful and culturally safe. 

As providers prepare for implementation, access to trustworthy research and guidance is more important than ever.

Why evidence matters in aged care

Aged care teams are often faced with uncertainty when caring for people nearing the end of life, many of whom will have complex health and psychosocial needs.

High-quality research evidence offers a firm foundation for decision-making. It reduces guesswork, helps services avoid repeating ineffective practices, and increases the likelihood that interventions will benefit older people and those who care for them.  

However, evidence alone is not enough. It must be interpreted and applied with professional judgement, recognising that each aged care setting is unique. What works well in one facility may need to be introduced differently in another, depending on staffing, available resources, local systems, and, most importantly, the individual’s needs, values, and preferences. 

For example, a recent evaluation of palliative care needs rounds in South Australian residential aged care facilities found that when structured, evidence-informed discussions led by specialist palliative care staff were embedded into routine care, confidence and care planning improved significantly for aged care staff.

Other research shows that these rounds lead to enhanced skills in symptom management and can improve resident quality of life and death.

However, outcomes depend on factors such as leadership, staff training, and implementation tailored to the setting, especially in rural areas where telehealth can be a critical enabler.

In other words, evidence must be thoughtfully introduced, not simply adopted in a one-size-fits-all manner.

Trusted guidance for the sector

PalliAGED evidence summaries synthesise current, high-quality research relevant to aged care to support informed decision-making across key areas of Outcome 5.7. 

They cover 27 topics, including advance care planning, recognising deterioration, communicating with families, psychosocial and spiritual care, and terminal care. Each was written with the aged care workforce in mind, using plain language and able to be translated into multiple languages. 

The evidence summaries are accompanied by an Improving Care page which translates the evidence into practical guidance for action. These paired resources give providers a clear, accessible way to develop evidence-based policies, procedures and staff training. 

The palliAGED Supporting Services section further highlights the importance of role-specific training, especially for care workers and nurses who are new to aged care. Here, providers will find a suite of training resources suitable for use at the point of care or as part of structured learning programs. Additional tools support workforce development, change management, and quality improvement across diverse care settings. 

The transition to the new Standards presents a timely opportunity to strengthen confidence and capability in aged care teams. The tools, training resources, and research evidence to support better end-of-life care are available to the sector. What’s needed now is the capacity to sift, weigh, and apply this knowledge thoughtfully, tailored to each service’s context, the preferences of older people, and the realities of day-to-day care delivery.

---