scholarly journals Video-telehealth to support clinical assessment and management of acutely unwell older people in Residential Aged Care: a pre-post intervention study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Carolyn Hullick ◽  
Jane Conway ◽  
Alix Hall ◽  
Wendy Murdoch ◽  
Janean Cole ◽  
...  
Keyword(s):  
Older People ◽  
Clinical Assessment ◽  
Hospital Admissions ◽  
Aged Care ◽  
Residential Aged Care ◽  
Post Intervention ◽  
Usual Practice ◽  
Aged Care Facilities ◽  
Ed Visits ◽  
Rate Ratios

Abstract Background Older people living in Residential Aged Care (RAC) are at high risk of clinical deterioration. Telehealth has the potential to provide timely, patient-centred care where transfer to hospital can be a burden and avoided. The extent to which video telehealth is superior to other forms of telecommunication and its impact on management of acutely unwell residents in aged care facilities has not been explored previously. Methods In this study, video-telehealth consultation was added to an existing program, the Aged Care Emergency (ACE) program, aiming at further reducing Emergency Department (ED) visits and hospital admissions. This controlled pre-post study introduced video-telehealth consultation as an additional component to the ACE program for acutely unwell residents in RACs. Usual practice is for RACs and ACE to liaise via telephone. During the study, when the intervention RACs called the ED advanced practice nurse, video-telehealth supported clinical assessment and management. Five intervention RACs were compared with eight control RACs, all of whom refer to one community hospital in regional New South Wales, Australia. Fourteen months pre-video-telehealth was compared with 14 months post-video-telehealth using generalized linear mixed models for hospital admissions after an ED visit and ED visits. One thousand two hundred seventy-one ED visits occurred over the 28-month study period with 739 subsequent hospital admissions. Results There were no significant differences in hospital admission or ED visits after the introduction of video-telehealth; adjusted incident rate ratios (IRR) were 0.98 (confidence interval (CI) 0.55 to 1.77) and 0.89 (95% CI 0.53 to 1.47) respectively. Conclusions Video-telehealth did not show any incremental benefit when added to a structured hospital avoidance program with nursing telephone support. Trial registration The larger Aged Care Emergency evaluation is registered with ANZ Clinical Trials Registry, ACTRN12616000588493.

scholarly journals Managing older people's money: assisted and substitute decision making in residential aged-care

2010 ◽  
Vol 31 (1) ◽  
pp. 93-109 ◽  
Author(s):  
CHERYL TILSE ◽  
JILL WILSON ◽  
LINDA ROSENMAN ◽  
DAVID MORRISON ◽  
ANNE-LOUISE MCCAWLEY
Keyword(s):  
Decision Making ◽  
Older People ◽  
Aged Care ◽  
Decision Makers ◽  
Cognitive Capacity ◽  
Residential Aged Care ◽  
Financial Assets ◽  
Aged Care Facilities ◽  
Financial Decision ◽  
Managing Risk

ABSTRACTCurrent approaches to the assessment of cognitive capacity in many jurisdictions seek to balance older people's empowerment with their protection. These approaches incorporate a presumption of capacity, a decision-specific rather than global assessment of that capacity, and an obligation to provide the support needed for adults to make or communicate their own decisions. The implication is that older people are assisted to make decisions where possible, rather than using substitute decision makers. For older people, decision making about financial matters is a contentious domain because of competing interests in their assets and concerns about risk, misuse and abuse. In residential-care settings, older people risk being characterised as dependent and vulnerable, especially in relation to decisions about financial assets. This paper reports an Australian study of the factors that facilitate and constrain residents' involvement in financial decision making in residential settings. Case studies of four aged-care facilities explored how staff interpreted the legislative and policy requirements for assisted and substitute decision making, and the factors that facilitated and constrained residents' inclusion in decisions about their finances. The observed practices reveal considerable variation in the ways that current legislation is understood and implemented, that there are limited resources for this area of practice, and that policies and practices prioritise managing risk and protecting assets rather than promoting assisted decision making.

Hospital admissions from residential aged care facilities to a major public hospital in South Australia (1999-2005)

2010 ◽  
Vol 30 (4) ◽  
pp. 202-207 ◽  
Author(s):  
Jodie B Hillen ◽  
Richard L Reed ◽  
Richard J Woodman ◽  
Deborah Law ◽  
Paul H Hakendorf ◽  
...  
Keyword(s):  
Public Hospital ◽  
Hospital Admissions ◽  
South Australia ◽  
Aged Care ◽  
Residential Aged Care ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

Creating the conditions for self-fulfilment for aged care residents

2012 ◽  
Vol 19 (6) ◽  
pp. 777-786 ◽  
Author(s):  
Sonya Brownie ◽  
Louise Horstmanshof
Keyword(s):  
Older People ◽  
Best Practice ◽  
Good Life ◽  
Institutional Care ◽  
Aged Care ◽  
Residential Aged Care ◽  
United Nations General ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

In 1991 the United Nations General Assembly adopted the Principles for Older Persons as a framework for international policy responses to population ageing. These principles promote independence, participation, care, self-fulfilment and dignity as legitimate entitlements of all older people. Although these principles, or variations of them, are embedded in standards of best-practice in residential aged care facilities, the literature shows that in reality institutional care can deny older people opportunities to exercise some of these entitlements. More specifically, residential aged care facilities can deprive older people of access and support to pursue opportunities for the full development of their potential, i.e. their entitlement to self-fulfilment. This discussion article explores the influence of institutional care on older people’s ability to exercise their entitlement to self-fulfilment. We identify the characteristics of a ‘good life’ in institutional care, according to aged care residents themselves. The Eden Alternative™ is presented as a model of aged care that aims to create the conditions for a ‘good life’ and self-fulfilment for aged care residents.

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