JCPSLP Vol 17 No 2 2015_web

Theme 2: Communication management in residential aged care is limited and impacted by numerous factors All participants stated that referral for speech pathology services and the nature of speech pathology services in residential aged care is dominated by “swallowing”. Only two of the 10 participants stated that they regularly provided communication management in aged-care settings. Participants also commented that communication management is often not a priority of aged-care management or care staff. One participant did, however, state, “I think the nursing staff prioritise communication the best way they know how” (Participant 3). Overall, most participants indicated that prioritisation of communication management in residential aged care by speech pathologists would not necessarily translate to increased aged-care sector prioritisation and support for communication management. All participants discussed the impact of lack of funding in residential aged care for communication management. Most participants discussed a lack of support from speech pathology management to provide communication management in residential aged care, and a lack of specialist training for speech pathologists working in the setting. All participants indicated that they felt strongly that limited funding for communication management was associated with many factors including: low prioritisation of communication management by facility staff; lack of acknowledgement of communication needs in aged- care funding allocation tools; and limited awareness by residential aged-care staff about, options for and the benefits of, speech pathology services to facilitate communication. Most participants also commented that they themselves had limited knowledge regarding funding options that were available for communication management in residential aged care. Further commenting on the support they received from their own professional management, all participants emphasised the negative impact of time and resource limitations. As a result, all participants prioritised what they were referred for – “swallowing”. One participant stated “I’m aware of everything, aware of communication, but I know I’ve got to hurry up and get out of there you know, I’m not allowed” (Participant 1). Many participants also indicated uncertainty about which resources and communication intervention approaches were best suited to meet residents’ needs. When asked about the nature of services they would provide to facilitate resident communication if given the opportunity, many participants expressed uncertainty about the intervention approach they would use, the areas of communication they would target, and the outcomes they would hope to achieve. This uncertainty largely related to the complex nature of communication impairment among residents of aged-care facilities, including the high prevalence of cognitive impairment, degenerative disease, and comorbidity. All participants commented that they would welcome further pre- and post-qualification training specific to facilitating communication in residential aged care, particularly for residents with cognitive-communication impairment. Many participants also expressed a desire for further training about expectations for client outcomes, reporting uncertainty about the applicability of, and means of implementing, a person-centred approach to

communication management in residential aged-care settings. All participants indicated that they were unsure about, how and whether speech pathology services should adhere to broader aged-care legislation and recommendations. When asked about current aged- care funding assessments and aged-care standards, participants made comments such as “I am not very clear on this” (Participant 1), “Again it doesn’t roll off my tongue with easy familiarity” (Participant 6), “I’m not sure specifically” (Participant 7), “Not too sure, I assume it is a set of standards that health professionals must comply with in order to work with the aged population” (Participant 3). Two participants who regularly conducted communication management in the residential aged-care settings they serviced both commented that the service they provided was highly dependent on the involvement of family members and friends of the resident. Family members and friends were noted as the primary source of referral for services to facilitate resident communication, often fund the service, and take a lead role in carrying out therapy tasks. Participant 8 discussed the role of speech pathologists in advocating for communication management in residential aged care: If relatives around see me working with someone else they might come and have a chat with me and ask what I am doing, and say that looks great, can I ask you about my relative … so I will have a chat with them. I think speech pathologists can raise awareness of what we can offer for communication and make this appealing to residential aged-care facilities. Theme 3: Speech pathologists have a desire to advance communication management in residential aged care Of the 10 participants, eight commented that in “an ideal world” they would like to increase services for communication management in residential aged care. Most participants emphasised the importance of facilitating social communication among residents. Most participants also commented on the importance of ensuring that the individual communication needs of residents were assessed and that interventions provided were tailored to meet these needs. In doing so, participants acknowledged that all residents are not the same, “They might all have dementia but are still all very, very different” (Participant 3). All participants discussed several different roles that speech pathologists may take in facilitating resident communication. These roles included as consultants and doing “trouble shooting” (Participant 6) with both staff and residents when communication breakdown occurred, as educationalists providing training for residential aged-care staff and family members in maximising communication opportunity and success, and as clinicians providing both individual and group assessment and intervention services. Discussion With national and international aged-care legislation and reform recommendations emphasising the importance of person-centred care and therefore the maintenance of personhood (Productivity Commission, 2011; Department of Health, 2012; WHO, 2002), services to facilitate effective communication with clients are essential. In a setting such as residential aged care, where the majority of clients experience communication difficulty, there is marked potential for speech pathology services to facilitate

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JCPSLP Volume 17, Number 2 2015

Journal of Clinical Practice in Speech-Language Pathology