Speak Out April 2021

Aged care

Models of service in aged care A changing environment

SPA Senior Advisor Aged Care Kym Torresi chats with the Association's new Adults/Aged Care Project Officer Nikki Gearon regarding her experiences working in aged care. Reflections on different models of service delivery in residential aged care is timely, given the recent

these same challenges which have necessitated a highly collaborative way of working. Collaboration occurs between management, allied health, the medical team, aged care staff and food services; this enables consistency across settings, with relevant information transferred between. Common policy and procedure guide quality care and staff education, including dysphagia training from speech pathologists for all staff. There are limitations to this model however, including ongoing issues of resourcing and still seeing a compression of scope of practice in a risk adverse environment. In response to this, and the introduction of the Aged Care Quality Standards, we developed a focused Aged Care Working Party to improve our model further. What has your local Aged Care Working Party achieved for your service? Our local ACWP has a discipline lead from each allied health profession, including speech pathology, occupational therapy, physiotherapy, dietetics and social work. Allied Health management also attend to guide decision making, liaise with aged care management and the executive for systemic change. In truth, initial sentiments were that of disillusionment; how do we meet the aged care standards with our current capacity? We began by reframing our thinking to what the service could look like with a well- being and enablement focus. We reviewed referrals and prioritisation to include not only risk analysis but also therapeutic intervention inclusive of resident goals. For example, speech pathology referrals to expand from risks of dysphagia, to include a resident’s goals for communication and ability to eat the foods they prefer. To address issues of funding and capacity, the model is centred around an allied health champion role which is currently a physiotherapist. This is an interdisciplinary role with block time allocation within a facility before variation based on referral activity. The role provides training and delegation to aged care staff, including enrolled nurses who are studying a Certificate IV in Allied Health Assistance. The team has also developed an interdisciplinary screener

recommendations within the Royal Commission into Aged Care Quality and Safety Final Report. What was your first experience working in aged care?

Nikki Gearon

I began working in aged care eight years ago, providing private speech pathology services into residential aged care facilities. Referrals were exclusively for swallowing and occurred only when a critical incident occurred, such as identification of aspiration pneumonia or a choking risk. The service included an initial assessment and perhaps a single review only, with no funding allocated toward education of residents, family or staff. Consequently, I organised a student to prepare and provide poster-based information regarding signs of dysphagia and safe swallowing strategies. At the time I didn’t feel I had the capacity or confidence to instigate facility level change; nor did Providers have the funding, staffing levels, or awareness of the full scope of speech pathology practice. Many SPA members report they experience similarly restrictive models of care in aged care happening today. How has your model of service changed over time? Since that time, I have worked in the public sector in a multidisciplinary outreach team model. The allied health team is hospital based and provides outreach services into the older person’s home and residential aged care facilities. Rurally based, we experience high travel demands, caseload diversity and workforce shortages; however, it is

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April 2021 | Speak Out