JCPSLP Vol 22 No 1 2020

Expanding possibilities: Foci on reading and interdisciplinary practices

Speech-language pathology in Australian residential aged-care facilities Skye A. Sewell and Suzanne C. Hopf

This narrative literature review aimed to identify the current speech-language pathology (SLP) service profile and service level factors influencing SLP service delivery in Australian residential aged-care facilities (RACFs). A rigorous and step-wise systematic database search was augmented with manual searches of grey literature related to aged-care policy and professional guidelines. Identified articles were then thematically analysed. There is limited research investigating SLP services delivered in RACFs where a range of multi-morbidities impact communication and swallowing function. Twenty-six sources were identified for thematic review. Major themes arising from the research included: the role of speech-language pathologists and factors influencing the provision of best-practice in RACFs. Sub-themes related to these barriers included: poor understanding of SLP scope of practice in RACFs; limited SLP roles in practice; potential impact of “ageism”; communication access and quality issues; and a lack of recognition of RACFs as a clinical specialty site for speech-language pathologists. Speech-language pathologists have a limited range of practice within RACFs despite significant need across both communication and swallowing disorders. RACFs should be recognised as a specialist SLP setting requiring unique clinician support, education and training. Barriers to service expansion need to be addressed to ensure that residents living in RACFs have access to the holistic, patient-centred care they have a right to receive. C are quality in Australian residential aged-care facilities (RACFs) has recently been questioned in both academic literature (Bennett, Ward, & Scarinci, 2015; Bennett, Ward, & Scarinci, 2016; Bennett, Ward, Scarinci, & Waite, 2015a; Bennett, Ward, Scarinci, & Waite,

2015b; Etherton-Beer, Venturato, & Horner, 2013; Walker & Paliadelis, 2016), and through the Royal Commission into Aged Care Quality and Safety (Smith, 2019). Many developed nations are grappling with the health service implications of ageing populations, and aged care has been described as “one of the greatest social challenges of the next decade” (Zeeb, 2018, p. 1). Australia’s ageing population is creating a greater need for aged care and government expenditure is predicted to double by 2055 (Smith, 2019), putting greater strain on budgets and workforces (Jeon, Glasgow, Merlyn, & Sansoni, 2010). This presents service delivery challenges at policy, funding, clinical practice and training levels. In the context of current Australian policy reforms in response to ageing population pressure and aged- care sector scrutiny, the need for SLP service in RACFs is growing and is increasingly recognised (Bennett, Cartwright, & Young, 2019; Bennett, Young, & Cartwright, 2019; Cartwright & Oliver, 2015; Chahda et al., 2017). Consequently, Australia is in the midst of aged-care policy reform attempting to respond to the increasing scale and complexity of consumer needs of the elderly (Bennett, Cartwright, & Young, 2019; Cartwright et al., 2015; Smith, 2019). Challenges include funding, regulatory frameworks, workforce size, training, retention and remuneration structures (Aged Care Workforce Strategy Taskforce [ACWST], 2018; Jeon et al., 2010; Prgomet et al., 2017; Smith, 2019). Recent legislative changes reflect a growing awareness of the need for services to be both patient- centred and consumer-directed, with a particular focus on greater choice for those wishing to age at home (Prgomet et al., 2017; Smith, 2019). Attention has also been given to early intervention to restore independence (Smith, 2019; Walker & Paliadelis, 2016); however, those needing high levels of care often require residential aged-care services. In Australia, the highest level of living support for the elderly is offered in RACFs (Smith, 2019). Here residents receive 24-hour nursing care, maximal assistance with activities of daily living (e.g., eating, dressing, hygiene, toileting, etc.) and palliative care (Smith, 2019). Internationally, RACFs may be referred to as long-term care, skilled nursing facilities, nursing homes or hostels. During 2017–2018, 241 723 Australians lived in RACFs run by 886 providers, 56% of which were not-for-profit organisations, 33% private businesses and 11% government sites (Smith, 2019). Despite this representing a small proportion of the 1.3 million Australians using aged-care services (Smith, 2019), these numbers represent some of the most

KEYWORDS ELDERLY RESIDENTIAL AGED-CARE SERVICE

DELIVERY SPEECH-

LANGUAGE PATHOLOGY

THIS ARTICLE HAS BEEN PEER- REVIEWED

Skye A. Sewell (top) and Suzanne C. Hopf

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JCPSLP Volume 22, Number 1 2020

www.speechpathologyaustralia.org.au