دورية أكاديمية
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Reform and reverberation: Australian aged care policy changes and the unintended consequences for allied health.

التفاصيل البيبلوغرافية
العنوان: Reform and reverberation: Australian aged care policy changes and the unintended consequences for allied health.
المؤلفون: Gibson D; Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australia., Isbel S; Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australia.
المصدر: Australian occupational therapy journal [Aust Occup Ther J] 2024 Jun; Vol. 71 (3), pp. 392-407. Date of Electronic Publication: 2024 May 07.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Blackwell Country of Publication: Australia NLM ID: 15420200R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1440-1630 (Electronic) Linking ISSN: 00450766 NLM ISO Abbreviation: Aust Occup Ther J Subsets: MEDLINE
أسماء مطبوعة: Publication: Melbourne : Blackwell
Original Publication: [Melbourne] Australian Assn. of Occupational Therapists.
مواضيع طبية MeSH: Allied Health Personnel* , Health Care Reform*, Humans ; Australia ; Occupational Therapy/organization & administration ; Health Policy ; Aged ; Health Services for the Aged ; Homes for the Aged/organization & administration ; Homes for the Aged/standards
مستخلص: Introduction: Allied health has a valuable role in providing services to people living in residential aged care. The recent Royal Commission into Aged Care Quality and Safety included several important recommendations relating to the nursing, personal care, and allied health workforce and the care that they provide. The purpose of this paper is to review these recommendations and the Australian Government's policy responses and explore the emerging changes in allied health service provision in residential aged care.
Methods: Data from the four available Quarterly Financial Reports from the 2022-2023 financial year were extracted and analysed in relation to staff costs and time per person per day across personal care, nursing, and allied health workers. Supplementary data sources including the 2020 Aged Care Workforce Census were accessed to provide contextual data relating to individual allied health professions, including occupational therapy.
Results: The analysis shows a modest increase in median registered nurse minutes per person per day, and cost per person per day, from the first to second quarter, and again in the third and fourth. By contrast, median time and cost for allied health declined. From 5.6 minutes per person per day in the first quarter, reported allied health minutes fell to 4.6 minutes per person per day in the second quarter, an 18% decrease, and by the fourth quarter was 4.3 minutes per person per day. This is just over half the Australian average of 8 minutes reported to the RCACQS in 2019.
Conclusion: Under recent residential aged care reforms, aged care providers have regulatory incentives to concentrate their financial resources on meeting the mandated care hours for registered nurses, enrolled nurses, personal care workers, and assistants in nursing. These same reforms do not mandate minutes of allied health services. Although providers of residential aged care in Australia continue to employ and value allied health, we argue that mandating care minutes for personal and nursing care without mandating the provision of allied health creates a perverse incentive whereby access to allied health services is unintentionally reduced.
(© 2024 The Authors. Australian Occupational Therapy Journal published by John Wiley & Sons Australia, Ltd on behalf of Occupational Therapy Australia.)
References: Aged Care Quality and Safety Commission. (2023). Quality Standards. Retrieved from https://www.agedcarequality.gov.au/providers/quality-standards.
Allied Health Professions Australia. (2022). The state of allied health in residential aged care survey results. Retrieved from https://ahpa.com.au/wp-content/uploads/2022/12/AHPA-Brief-State-of-Allied-Health-in-Residential-Aged-Care-Survey-Results-December-2022.pdf.
Allied Health Professions Australia. (2023). What is allied health. Retrieved from https://ahpa.com.au/what-is-allied-health/.
Australian Institute of Health and Welfare. (2021). National health workforce dataset. Retrieved from https://hwd.health.gov.au.
Australian Institute of Health and Welfare. (2023). Older Australians. Retrieved from https://www.aihw.gov.au/reports/older-people/older-australians/contents/summary.
Bevan, G., & Hood, C. (2006). What's measured is what matters: Targets and gaming in the English public health care system. Public Administration, 84(3), 517–538. https://doi.org/10.1111/j.1467-9299.2006.00600.x.
Braithwaite, J., Makkai, T., & Braithwaite, V. A. (2007). Regulating aged care: Ritualism and the new pyramid. Edward Elgar Publishing. https://doi.org/10.4337/9781847206855.
Causey‐Upton, R. (2015). A model for quality of life: Occupational justice and leisure continuity for nursing home residents. Physical and Occupational Therapy in Geriatrics., 33(3), 175–188. https://doi.org/10.3109/02703181.2015.1024301.
Commonwealth of Australia. (2020). Aged care workforce census report. Retrieved from https://www.health.gov.au/sites/default/files/documents/2021/10/2020-aged-care-workforce-census.pdf.
Dancewicz, E. A., & Bissett, M. (2020). Occupational therapy interventions and outcomes measured in residential care: A scoping review. Physical & Occupational Therapy in Geriatrics, 38(3), 230–249. https://doi.org/10.1080/02703181.2020.1719272.
Dementia Australia. (2019). Workforce submission to the Royal Commission into Aged Care Quality and Safety. Retrieved from https://www.dementia.org.au/sites/default/files/submissions/DA-workforce-submission-to-royal-commission.pdf.
Department of Health and Aged Care. (2016). Aged Care Funding Instrument (ACFI) User Guide. Retrieved from https://www.health.gov.au/resources/publications/aged-care-funding-instrument-acfi-user-guide?language=en.
Department of Health. (2020). 2020 aged care workforce census report. Retrieved from https://www.health.gov.au/sites/default/files/documents/2021/10/2020-aged-care-workforce-census.pdf.
Department of Health and Aged Care. (2021). Australian Government response to the final report of the Royal Commission into aged care quality and safety. Retrieved from https://www.health.gov.au/sites/default/files/documents/2021/05/australian-government-response-to-the-final-report-of-the-royal-commission-into-aged-care-quality-and-safety.pdf.
Department of Health and Aged Care. (2022). Star ratings provider manual. Retrieved from https://www.health.gov.au/sites/default/files/2023-02/star-ratings-provider-manual.pdf.
Department of Health and Aged Care. (2023a). About star ratings. Retrieved from https://www.health.gov.au/our-work/star-ratings-for-residential-aged-care/about-star-ratings.
Department of Health and Aged Care. (2023b). About the Australian National Aged Care Classification funding model. Retrieved from https://www.health.gov.au/our-work/ANFan-ACC-ACC/abou.
Department of Health and Aged Care. (2023c). The Australian National aged care classification (AN‐ACC) funding guide. Retreived from https://www.health.gov.au/resources/publications/the-australian-national-aged-care-classification-an-acc-funding-guide?language=en.
Department of Health and Aged Care. (2023d). Care minutes and 24/7 registered nurse responsibility guide. Retrieved from https://www.health.gov.au/resources/publications/care-minutes-and-247-registered-nurse-responsibility-guide?language=en.
Department of Health and Aged Care. (2023e). Aged care reform roadmap. Retrieved from https://www.health.gov.au/our-work/aged-care-reforms/roadmap.
Department of Health and Aged Care. (2023f). Quarterly financial snapshot: Quarter 1 2022‐2023. July ‐ September 2022. Retrieved from https://www.health.gov.au/topics/aged-care/aged-care-research-and-reporting#quarterly-financial-snapshot-on-the-australian-aged-care-sector.
Department of Health and Aged Care. (2023g). Quarterly financial snapshot: Quarter 2 2022‐2023. October to December 2022. Retrieved from https://www.health.gov.au/topics/aged-care/aged-care-research-and-reporting#quarterly-financial-snapshot-on-the-australian-aged-care-sector.
Department of Health and Aged Care. (2023h). Quarterly financial snapshot: Quarter 3 2022‐2023. January to March 2023. Retrieved from https://www.health.gov.au/resources/publications/quarterly-financial-snapshot-of-the-aged-care-sector-quarter-3-2022-23-january-to-march-2023?language=en.
Department of Health and Aged Care. (2023i). Quarterly financial snapshot: Quarter 4 2022‐2023. April to June 2023. Retrieved from https://www.gen-agedcaredata.gov.au/resources/reports-and-publications/2023/december/quarterly-financial-snapshot-of-the-aged-care-sector-%E2%80%93-april-to-june-2023.
Department of Health and Aged Care. (2023j). Allied health workforce statistics. Retrieved from https://hwd.health.gov.au/resources/publications/factsheet-alld-2019.html.
Department of Health and Aged Care. (2023k) AN‐ACC assessment. Retrieved from https://www.health.gov.au/our-work/AN-ACC/providers/assessments#anacc-independent-assessors.
Dietitians Association of Australia. (2019). Submission to the Royal Commission into Aged Care Quality and Safety. Retrieved from https://dietitiansaustralia.org.au/sites/default/files/2022-01/201903-Submission-Royal-Commission-Aged-Care.pdf.
du Toit, S. H., Casteleijn, D., Adams, F., & Morgan‐Brown, M. (2019). Occupational justice within residential aged care settings—Time to focus on a collective approach. British Journal of Occupational Therapy, 82(9), 578–581. https://doi.org/10.1177/0308022619840180.
Eagan, C. (2023). ‘It's impossible’: Mandatory care minutes will not be met. Accessed from https://www.theweeklysource.com.au/aged-care/its-impossible-mandatory-care-minute-targets-wont-be-met.
Eagar, K., Westera, A., Snoek, M., Kobel, C., Loggie, C., & Gordon, R. (2019). How Australian residential aged care staffing levels compare with international and national benchmarks. Australian Health Services Research Institute, University of Wollongong.
Eager, K., Gordon, R., Snoek, M., Loggie, C., Westera, A., Samsa, P., & Kobel, C. (2020). The Australian national aged care classification (AN‐ACC): A new casemix classification for residential aged case. Medical Journal of Australia, 213(8), 359–363. https://doi.org/10.5694/mja2.50703.
Fair Work Commission. (2024). Summary of decision. Accessed from https://www.fwc.gov.au/documents/decision-summaries/2024fwcfb150-summary.pdf.
Frändin, K., Grönstedt, H., Helbostad, J. L., Bergland, A., Andresen, M., Puggaard, L., Harms‐Ringdahl, K., Granbo, R., & Hellström, K. (2016). Long‐term effects of individually tailored physical training and activity on physical function, well‐being and cognition in Scandinavian nursing home residents: A randomized controlled trial. Gerontology, 62(6), 571–580. https://doi.org/10.1159/000443611.
Gibson, D. (2022). Aged care employment and the productivity commission: Fixing the data gaps may be the most useful thing it can do. Australasian Journal on Ageing, 41(4), 573–578. https://doi.org/10.1111/ajag.13113.
Health Care Australia. (2020). AN‐ACC vs ACFI: a quick comparison. Retrieved from https://healthcareaustralia.com.au/an-acc-vs-acfi-a-quick-comparison/.
Livingstone, I., Hefele, J., & Leland, N. (2022). Physical and occupational therapy staffing patterns in nursing homes and their association with long‐stay resident outcomes and quality of care. Journal of Aging & Social Policy, 34(5), 723–741. https://doi.org/10.1080/08959420.2020.1824544.
Mavromaras, K., Knight, G., Isherwood, L., Crettenden, A., Flavel, J., Karmel, T., Moskos, M., Smith, L., Walton, H., & Wei, Z. (2017). The aged care workforce 2016. Australian Government Department of Health. https://agedcare.royalcommission.gov.au/system/files/2020-06/CTH.0001.1001.2805.pdf.
Merton, R. K. (1936). The unanticipated consequences of purposive social action. American Sociological Review, 1(6), 894–904. https://doi.org/10.2307/2084615.
Meulenbroeks, I., Raban, M. Z., Seaman, K., & Westbrook, J. (2022). Therapy‐based allied health delivery in residential aged care, trends, factors, and outcomes: A systematic review. BMC Geriatrics, 22(1), 712. https://doi.org/10.1186/s12877-022-03386-9.
Muller, J. (2018). The tyranny of metrics. Princeton University Press.
Occupational Therapy Australia. (2019). Royal Commission in Aged Care Quality and Safety: Occupational Therapy Australia submission. Retrieved from https://otaus.com.au/publicassets/93ab33bb-20fc-e811-a2c2b75c2fd918c5/Feb%202018%20Inquiry%20into%20the%20quality%20of%20care%20in%20residential%20aged%20care%20facilities%20in%20Australia.pdf.
Palliative Care Australia. (2019). Submission to the Royal Commission into Aged Care Quality and Safety. Retrieved from https://palliativecare.org.au/wp-content/uploads/2019/11/PCA-Submission-to-the-Royal-Commission-into-Aged-Care-Quality-and-Safety-October-2019.pdf.
Portillo, C. U., Calvo Arenillas, J. I., & Miralles, P. M. (2022). Occupational therapy interventions for the improvement of the quality of life of healthy older adults living in nursing homes: A systematic review. American Journal of Health Promotion., 37(5), 698–704. https://doi.org/10.1177/08901171221145159.
Power, M. (2007). The theory of the audit explosion. In E. Ferlie, L. E. Lynn, Jr., & C. Pollit (Eds.), The Oxford handbook of public management (pp. 326–344). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199226443.001.0001.
Royal Commission into Aged Care Quality and Safety (RCACQS). (2020). Counsel Assisting's Submissions on Workforce. https://agedcare.royalcommission.gov.au/publications/counsel-assistings-submissions-workforce.
Royal Commission into Aged Care Quality and Safety (RCACQS). (2021). Final Report Volume 1. Retrieved from https://agedcare.royalcommission.gov.au/.
Royal Commission into Aged Care Quality and Safety (RCACQS). (2021a). Counsel Assisting's Final Submissions Proposed Recommendations. 2021 Retrieved from https://agedcare.royalcommission.gov.au/sites/default/files/-02/RCD.9999.0541.0001.pdf.
World Federation of Occupational Therapists. (2012). About occupational therapy. Retreived from https://wfot.org/about/about-occupational-therapy.
World Federation of Occupational Therapists. (2021). Occupational therapy and ageing across the life course. Retreived from https://wfot.org/resources/occupational-therapy-and-ageing-across-the-life-course.
فهرسة مساهمة: Keywords: allied health; nursing home; occupational therapy; policy; regulation; residential aged care
تواريخ الأحداث: Date Created: 20240507 Date Completed: 20240606 Latest Revision: 20240606
رمز التحديث: 20240606
DOI: 10.1111/1440-1630.12953
PMID: 38714528
قاعدة البيانات: MEDLINE
الوصف
تدمد:1440-1630
DOI:10.1111/1440-1630.12953